Hospice Care

Most HMSA plans include benefits for hospice care. To determine if hospice care is a benefit of your patient's HMSA plan, please access the Hawaii Healthcare Information Network (HHIN+) or call a Provider Teleservice Representative.

A patient is eligible for hospice care when he or she has a life expectancy of six months or less. The hospice assesses the level of care appropriate for the terminally ill patient.

Services Covered Under the Hospice Care Benefit

A patient in a hospice program may receive any of the following services:

• Continuous home care - predominantly nursing care provided to a hospice patient during a crisis period, thereby enabling him or her to remain at home.
• Routine hospice care - routine hospice care that takes place in the patient's home or in a hospice care facility. A patient may not receive both continuous home care and routine hospice care concurrently.
• Inpatient respite care - the patient may receive up to five days of inpatient care (to give the primary caregiver a respite).
• General inpatient care - the patient may receive general inpatient care for pain control or the management of acute and severe clinical problems that cannot be managed in other settings.

The intent of the hospice benefit is to provide outpatient hospice services in lieu of regular plan benefits. However, the hospice provider agrees to provide respite care and general inpatient care if these services become necessary. If the participating agency does not have an inpatient setting, the agency will make arrangements at a hospital or skilled nursing facility at no additional cost to the patient or HMSA.

Benefit Limitations

The following limitations apply to coverage for hospice services:

• Benefits for hospice services are available only when provided by agencies contracting with HMSA or participating Blue Cross and/or Blue Shield Plans. Hawaii hospices are listed in section 1 of HMSA's Directory of Preferred Plan Participating Providers. For assistance in locating an out-of-state hospice provider, call 1 (800) 810-BLUE or log on to www.bluecares.com.
• While under hospice care, a patient is not eligible for other medical plan benefits for the treatment of the terminal illness, except for physician services. The patient may receive medical benefits to treat an illness or injury unrelated to the terminal illness.
• Benefits for room and board are part of an all-inclusive daily rate paid to the hospice and may not be billed separately.

• Home hospice coverage is available to Federal Employee Program (FEP) members who have a life expectancy of six months or less; no copayment applies. Inpatient hospital hospice coverage for FED members has a $100 per admission copayment for standard option and a $100 per day copayment for basic option. Benefits are provided for up to five consecutive days and each stay must be separated by 21 days. FEP requires prior authorization for hospice care; requests should be sent to:

  Pre-certification Request, 6th floor
  HMSA - Medical Management Department
  P.O. Box 2001
  Honolulu, HI  96805

  - or -

  Fax:  808-944-5611

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