What Contracts Does a Hospice Agency Need for Medicare Certification?

*This article was written in consultation with Mariam Treystman.

Worried your agency might miss something before survey? If you're running a Medicare-certified hospice, you already know how high the stakes are. You’ve invested in systems, staffing, and training—but one overlooked contract could still lead to a failed survey.

Hospice owners often ask: “Which contracts are absolutely required, and what will surveyors look for?”

This guide breaks down what you need to know about:

• Hospice Durable Medical Equipment Contracts
• Hospice Pharmacy Contracts
• Hospice Skilled Nursing Facility Contracts
• Hospice Staffing Agency Contracts
• How Often Hospice Contracts Should be Reviewed
• How to Meet Medicare Hospice Contract Compliance Requirements

Whether you’re preparing for initial accreditation, recertification, or a routine survey, this list will help you avoid costly missteps.

What Kind of DME Contract Does a Hospice Agency Need?

As your patients decline, they’ll likely require equipment like oxygen tanks, wheelchairs, or hospital beds. This equipment is called Durable Medical Equipment, or DME. To provide quality care, your agency must have a contract with a Medicare-certified, CMS-approved DME provider.

This contract must be current, signed, and available at the time of survey. If it’s missing, or if your vendor isn’t properly certified, your agency risks survey deficiencies or worse.

Pro Tip: Having multiple DME agreements is also a smart move. It ensures patients have uninterrupted care, even if your primary vendor is unavailable.

Does a Hospice Agency Need a Pharmacy Contract?

Securing a pharmacy contract for your hospice agency is absolutely a necessity. But it’s important to know not just any pharmacy will do.

Because hospice patients are within 6 months of the end of their lives, they may need emergency medications delivered the same day, or night. They may even need that medication within hours.

That’s why you need a dedicated hospice pharmacy—one that supports 24/7 delivery and understands the unique demands of end-of-life care.

Most hospice pharmacies charge a flat monthly rate per patient. That’s standard and surveyors understand it. What surveyors want to see is a clear, compliant contract that spells out timelines, access protocols, and after-hours support.

Why Do Hospice Agencies Need a Skilled Nursing Facility (SNF) Contract?

Even if you provide care in the home, your agency still needs a contract with a Medicare-certified Skilled Nursing Facility (SNF). This surprises many hospice owners, but it’s non-negotiable.

Hospice patients sometimes require respite care or facility-based support when symptoms become unmanageable at home. Respite care is intended to give caregivers and family a mental, emotional, and physical break from looking after their loved ones. Your SNF contract ensures those transitions are safe, appropriate, and aligned with the hospice plan of care.

Make sure the facility is Medicare-certified and that your agreement reflects its role in hospice, not in rehabilitation.

Is a Staffing Agency Contract Required for Hospice Agencies?

Technically, your hospice agency is not required to work with a staffing company. However, this is an incredibly common practice with newer or smaller hospice agencies. It’s also common in urban areas where clinicians work across multiple agencies through staffing partners.

These staffing agencies typically provide PT, OT, or speech therapy services. While these aren’t used very often in hospice, they’re still part of the team when appropriate. And when appropriate, you need to make sure you have qualified PTs, OTs, or STs readily available.

If you do work with a staffing agency, make sure your contract outlines:

• Clinician qualifications and licensing
• Scope of services
• Documentation standards

Surveyors will expect to see this contract, even if the services are only used occasionally.

How Often Should Hospice Contracts Be Reviewed?

One of the biggest most common mistakes hospice agencies face isn’t forgetting a contract, it’s letting one go stale.

Surveyors routinely find expired agreements, unsigned pages, or contracts with vendors who have lost certification. That’s why it’s critical to review your contracts regularly and keep them up to date.

Confirm that:

• All documents are signed and up to date
• DME and SNF vendors remain Medicare-certified
• Any third-party vendors still meet compliance standards
• Contracts include auto renew clauses

Being proactive here can prevent unnecessary deficiencies or worse, survey failure.

How Hospice Agencies Can Stay Contract-Compliant and Survey-Ready

To recap, your hospice agency must have compliant, current contracts for: 

• Durable Medical Equipment (DME)
• 24-hour pharmacy services
• a Medicare-certified Skilled Nursing Facility (SNF)
• *If you work with a staffing agency, that contract should also be formalized and ready for review. 

These contracts are more than just paper—they’re essential safeguards for quality care and regulatory compliance. In the real world, agencies are cited or fail surveys every year because of contract issues that could have been caught with a simple review. Take time now to assess your contracts, identify gaps, and correct any issues before your next survey. It’s one of the most straightforward ways to protect your agency, your staff, and your patients.

Download our Required Hospice Contracts Checklist to quickly see which contracts your agency needs to have in place—and what should be included in each. It’s a simple tool that can help you stay organized and compliant.