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Curative Care for Hospice Patients under Age 21

Thursday, September 5, 2019

TRICARE’s current hospice care benefit follows Medicare’s model, which offers palliative care (pain control, support) to patients who have less than six months to live. On Sept. 6, 2019, TRICARE is implementing a revised hospice benefit to include concurrent hospice services and curative care for the same condition for beneficiaries under age 21. As directed by Congress, this aligns TRICARE with Medicaid’s model, and can help improve the quality of life for younger patients who suffer from life-threatening conditions. 

In order to qualify for concurrent hospice and curative care, beneficiaries must: 

  • Be under age 21 with a life expectancy of six months or less, if the terminal illness has run its normal course. 
  • Meet hospice eligibility and admission criteria. 
  • Have a referral to a participating hospice from an authorized provider. 
  • Have a signed and dated certification/attestation of terminal illness from the referring provider and the hospice medical director. 

All hospice care requires approval from Health Net Federal Services, LLC (HNFS). Approval requirements for curative care for beneficiaries under the age of 21 who have elected hospice vary by TRICARE plan type. (The curative care must be for the terminal condition for which hospice was authorized.) Separate TRICARE copayments, cost-shares and deductibles apply for curative care.

Referring providers must submit a consolidated (palliative and curative) treatment plan to the hospice within three days of the referral. 

  • The hospice will work with the beneficiary and family on updates to the treatment plan, care coordination and treatment options. 
  • The hospice must submit treatment plan updates to HNFS on a monthly basis. HNFS’ Case Management team will work with the hospice care coordinator on this process. 

If curative care is successful, the beneficiary can ask to have the hospice benefit end. If the disease later returns or the beneficiary is diagnosed with a new terminal condition, the beneficiary can get two more 90-day episodes of care, followed by an unlimited number of 60-day periods. 

For additional benefit details, please visit our Hospice Care benefit page.