Hospice Services
Defines CareFirst coverage stance for hospice and palliative care services for terminally ill members including levels of care (routine home, inpatient, continuous home care, respite), benefits, preauthorization requirement, and applicability relative to member contracts and clinical trials.
Policy metadata shows Original MPC Approval 09/17/2018, Last Review 11/12/2025, Effective Date 02/01/2026.
Coverage Summary
CareFirst considers hospice and palliative care services covered with criteria for members who are terminally ill as defined by the member's contract. Members may continue receiving palliative care services and medically necessary services are determined at CareFirst's discretion.
CareFirst recognizes the following levels of hospice care: Routine Home Care, Inpatient Care, Continuous Home Care (CHC), and Respite Care.
Applicability: coverage and any prior authorization requirements depend on the member's contract and line of business; contract provisions supersede this policy. Hospice services (home and inpatient/facility) must be preauthorized per CareFirst provider guidance.
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