I'm no expert, so I may get some things wrong, but this is my experience.
Hospice is a federally mandated program for persons with a limited life expectancy. Hospice emphasizes palliative rather than curative treatment; quality rather than quantity of life. The patient's DR/DRs do need to OK a Hospice organization to evaluate the patient's appropriateness to Hospice. If you want to talk to more than one Hospice organization, the DR has to OK each evaluation.
There may be various Hospice organizations covering a single service area. If you are lucky enough to be in that position, you should interview more than one, and ask detailed questions about the nature and frequency of care you would receive. I interviewed 3 for my husband, who is now in the program, and found vast differences. Ask specific questions about the type of nursing/medical procedures you are likely to want to have. One hospice might consider procedure X to be palliative while another hospice considers that same procedure curative. For example, I interviewed one that would not authorize my husband to have his blood drawn for evaluation, saying that was an invasive procedure. My husband gets his blood drawn every week to check his liver, kidney, and electrolyte values, so that we can appropriately adjust his medications. One hospice might provide a personal aide 5 days a week; another 3 days a week.
If a patient is accepted into Hospice, they are cared for (under their terminal diagnosis) regardless of ability to pay. If there is any insurance involved (Medicare, Medicaid, or private), Hospice will bill those sources for their services. Hospice will provide all medications prescribed for the terminal diagnosis or needed for palliative care, many "soft" supplies (such as latex gloves and duoderm bandages for pressure sores), necessary durable medical equipment (hospital bed, walker, wheelchair, cane). All this is provided without cost to the patient, even if the patient has no insurance. (Many Hospices have private donations to finance their "charity" care.) The Hospice does not provide coverage for conditions unrelated to the terminal diagnosis. For example, if my husband were to fall and break his leg, Hospice doesn't cover that.
Many hospices provide home-based serevices, but some have their own facilities. Most have contractual arrangements with facilities (hospitals and long-term care homes) if those services are needed. Most Hospices work to "back up" friends or family members, who provides the primary caregiving (unless there are no primary caregivers).
A Hospice patient is initially "certified" for, I think, 9 months, and may be "certified" for a second 9-month period. After that "certification" comes in 6-month increments. Certification subsequent to the initial one involves consensus among the Hospice team, in consultation with the primary caregivers and the patient's DR/DRs, that the person continues to qualify.
You can withdraw from Hospice at any time. You may be releaased from Hospice if you seek "currative" treatment, depending on how your Hospice defines that. For example, one Hospice told me that anytime my husband went into a hospital, he would be discharged from Hospice. The one I chose had a different philosophy. I gave them the example of spontaneous bacterial peritonitis and the need for IV antibiotics and ICU care. Our Hospice agreed that would not be "currative" of his terminal disgnosis, but simply intended to make him comfortable. Depending on the specifics, our Hospice might require him to withdraw, so that traditional Medicare would cover the cost or they might keep him under Hospice care while in ICU and pay for his stay.
I was told that if a patient withdraws from or is released from Hospice enough times, the Hospice may consider that the patient is seeking "a cure" and refuse to recertify the patient. Once again, this is a matter of philosophy for a particular Hospice and a particular diagnosis.
I had one Hospice tell me that seeking to be on a liver transplant list constitutes a currative path and they would discharge Jim. The one he is with told me that simply seeking to be listed and being listed is not currative; a currative path does not occur until the call comes in that a liver is available and we get in the car to go to the transplant center.
Take care and good luck,
Venita and Jim