Guidelines for Extraordinary Needs Funding

GUIDELINES FOR EXTRAORDINARY NEEDS FUNDING

FOR INDIGENT HOSPICE PATIENTS AND THEIR FAMILIES

Big “R” & Smokin’ Joe’s Hospice Benefit will primarily fund extraordinary needs of indigent hospice patients through donations contributed to the Big “R” & Smokin’ Joe’s Hospice Benefit. The purpose is to enrich the lives of these patients and their families by relieving distress/hardship.

Funding for extraordinary needs beyond what a hospice would normally provide is available to all hospice patients who qualify under the guidelines. Funds will not be allocated for patient's needs that should be met by the hospice under the reimbursement system of Medicare, Medicaid or third party payment.

GRANT REQUESTS MUST ADHERE TO THE FOLLOWING PROCEDURES:

The interdisciplinary team caring for the patient, the professional caregiver or a not-for-profit organization helping hospice patients/families may make the request for funding an extraordinary need. The person making this request, and a board member or supervisor of Hospice signature is required on the request form submitted to Big “R” & Smokin’ Joe’s Hospice Benefit.

Completion of the "Extraordinary Needs Grant Request Form” and the “Financial Assessment Worksheet must be filled out in it’s entirety! Please download and send the email or USPS the form and worksheet to Big “R” & Smokin’ Joe’s Hospice Benefit along with an INVOICE, or LETTER from the vendor/provider of service. Big “R” & Smokin’ Joe’s Hospice Benefit email is

The request will be reviewed and the appropriate person in the hospice program or not-for-profit organization will be advised of the results by telephone, letter or email as appropriate.

If approved, a check will be issued to the vendor or service provider. Personal Checks are never issued to the patient/family or hospice staff member. Payment will be sent by regular mail unless the need is urgent.

FUNDS WILL NOT BE ALLOCATED FOR PATIENT'S NEEDS THAT SHOULD BE MET BY THE HOSPICE UNDER THE REIMBURSEMENT SYSTEM OF MEDICARE, MEDICAID/MEDICAL, OR THIRD PARTY PAYMENT!

Examples of Extraordinary Needs that may beFundedif Not Funded Elsewhere

Big “R” & Smokin’ Joe’s Hospice Benefit will use $5000 of the funds we raise each year, starting fiscal year January 1, 2015.

Costs shown are “Up To” what Big “R” and Smokin’ Joe’s Hospice will pay.

$100 Basic Cable TV / $300 Rent / $100 Emergency Clothing
$100 Window Air Conditioner / $200 Repair Glasses / $100 Personal Items
$200 Small TV, DVD or Radio / $300 Heating Oil/Propane / $300 Repair AC/Furnace
$300 Utility Bills
(Not Cell Phone) / 5% of Respite Care,
$250 max

Only in extraordinary circumstances may the grant exceed the above amounts in that particular area. Any grant request above $500 must be reviewed by the President or Vice President.

Examples of Extraordinary Needs that are usually Not Funded by Big “R” & Smokin’ Joe’s Hospice Benefit:

Medicine

Credit Cards

Life Line Equipment

Medical Insurance

Life Insurance

Taxes

Yard Care

Annual service contracts

Disney Trips

Car Rental

Motor Wheelchair

Nursing Home or ALF monthly fee

If the patient/family have funds in an account to cover expense, the request will be denied.

Any exception to the above must be approved by the President or Vice President.