Back to Main     Print Full Version     Understanding Hospice Care (Article 12) Providers Can Ease Difficult End-of-Life Decisions by Helping Patients Make Informed Choices   Hospice care is a choice for TRICARE patients with a terminal illness who are expected to live less than six months. It is a global treatment approach that offers a broad variety of supportive, palliative care and services to meet patients’ end-oflife needs. In keeping with the principles of family-centered care, the patient’s wishes and those of family members and friends figure prominently in care decisions. Here’s what you should know when you counsel your patients about hospice care. What Does Hospice Care Cover? Hospice covers four levels of care: routine home care, continuous home care, inpatient respite care and general hospice inpatient care. One of these levels will be in use at all times, and patients often shift among all four, depending on their needs and the needs of family members who are supporting them. Care within these levels may include physician services, nursing care, counseling, medical equipment and supplies, medications, medical social services, physical and occupational services, speech and language pathology, and hospice short-term acute patient care related to the terminal illness. Hospice care does not contain the limits on custodial care and personal comfort items currently in force under the basic TRICARE coverage rules. However, services for an unrelated condition or injury, like a broken bone or unrelated diabetes, are still covered as a regular TRICARE benefit. What Doesn't Hospice Care Cover? Room and board are not covered under hospice care unless the patient is receiving inpatient level of care. Patients also cannot receive other services/benefits (e.g., curative treatment related to the terminal illness) outside the hospice coverage unless the hospice care is formally revoked. In other words, no care is covered by TRICARE unless the hospice provides it or arranges for it. Beneficiaries must submit a signed, dated statement through the hospice provider to formally revoke the hospice election. This does not alter the beneficiary’s ability to reenter hospice care at a later time. What is the Patient's Responsibility? The patient has no deductible under the hospice benefit. The hospice provider may bill the patient for 5 percent of the cost of outpatient drugs, or $5 toward each prescription, whichever is less. The provider may bill the patient for a cost-share for each respite care day equal to 5 percent of the amount TRICARE has estimated to be the cost of respite care, after adjusting the national rate for local wage differences. Where Is Hospice Care Provided? Hospice care can be provided in a number of settings: at home, in a hospice facility or in a military treatment facility (MTF). Care can shift between these facilities without affecting the hospice benefit. For example, suppose a hospice patient is receiving care at home, but his or her support system breaks down or the family member providing care needs a break. The patient can receive inpatient hospice care, or respite care, at an MTF or hospice facility as part of the hospice benefit. How Should Hospice Care Be Initiated? You should discuss hospice care with terminally ill patients who are considered to have six months or less to live as an option for them and their family members in handling their care. As part of their decision-making process, patients may also request a consultation with a hospice facility to ask questions and learn more about how they will be cared for. Referring providers may wish to participate in this consultation. Either the patient, his or her PCM, or a family member acting on the patient’s behalf can initiate hospice care, but the hospice will not take action without a doctor’s order. Patients must complete an “election statement” that indicates their understanding of what hospice care involves. This statement, available through the hospice facility, must be filed with the regional contractor. The patient must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS) to be eligible for and to initiate hospice care. Hospice care is provided in three benefit periods, each of which requires prior authorization. The patient’s PCM should initiate and obtain the prior authorization from Humana Military on the patient’s behalf.  The first two benefit periods are each 90 days long and begin on the day that a hospice election statement is signed by the beneficiary and a physician’s certificate of terminal illness is signed by both the attending physician and the hospice medical director. The final benefit period comprises an unlimited number of 60-day periods, each of which requires recertification of the terminal illness. How Can Beneficiaries Find a Hospice? The best way for beneficiaries to find a TRICARE-authorized hospice is to use the regional contractor’s provider directory. Humana Military’s provider directory is accessible online or by calling 1-800-444-5445. How Are Hospice Care Decisions Made? Once patients elect hospice care, their care is managed by the medical director of the hospice as part of the interdisciplinary clinical team managing the case, always in consultation with patients and their families. PCMs may stay involved and participate in the clinical team, as well as manage any acute needs outside hospice coverage. Where Can I Find Additional Information? Review Chapter 11 of the TRICARE Reimbursement Manual for detailed information. Back to Top