Hospice
Defines UnitedHealthcare West coverage requirements, limits, and exclusions for hospice services in California, aligned with federal/state regulations; includes covered benefits, not-covered items, state market enhancements, and operational rules (e.g., respite limits, in-network requirement).
Routine review; no change to coverage guidelines
Coverage Summary
UnitedHealthcare West covers hospice services with criteria (covered_with_criteria). Coverage is effective August 1, 2025 and last reviewed on August 1, 2025. Hospice is covered when all eligibility criteria are met, including that the member has a terminal illness with a prognosis of life expectancy of one year or less if the disease follows its natural course, services are provided by an appropriately licensed hospice or Medicare-certified home health agency, and a written interdisciplinary plan of care is established and services are reasonable and necessary for palliation and management of the terminal illness.