Tricare hospice coverage and benefit period

Hospice Care

TRICARE has adopted most of the provisions currently set out in Medicare’s hospice coverage benefit guidelines, reimbursement methodologies, and certification criteria for participation in the hospice program. The hospice benefit is designed to provide palliative care to individuals with prognoses of less than six months to live if the terminal illness runs its normal course. This type

of care emphasizes supportive services, such as pain control and home care, rather than cure- oriented treatment.

All TRICARE beneficiaries are eligible for the hospice benefit.

Hospice care must be provided by a Medicare-certified hospice agency. If the  hospice provider is not currently TRICARE-certified, it may download the Institutional Provider File Application form at www.triwest.com/provider in the “Find a Form” section.

Exclusions

There is no reimbursement for room-and-board charges for a patient who is receiving hospice services in the home. Room and board is not a covered hospice benefit when a patient is placed in a facility, such as a rest home, and the care is custodial. Patients also cannot receive other TRICARE services/benefits related to the treatment of the terminal illness for which hospice care is elected unless the hospice care is formally revoked. No care for the illness is covered by TRICARE unless the hospice provides it or arranges for it.

Benefit Periods

Hospice care is provided in three benefit periods, each of which requires a separate authorization:

•     First 90-day period

•     Second 90-day period

•     Unlimited number of 60-day periods