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Coverage criteria policies

Hospice Services - Iowa

These services may or may not be covered by all HealthPartners Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Notification is required within the next business day of a member’s enrollment into a hospice program or disenrollment from a hospice program.

Please see related content at the right for link to Hospice Election Communication Form.

Prior authorization is required for the following:

  • Respite care
  • Continuous care
  • Inpatient services at a Hospice facility
  • Inpatient services related to acute symptom management of terminal illness

Prior authorization is not required for the following:

  • Medically necessary durable medical equipment (DME)
  • Formula or supplements, such as Ensure, when it is the sole source of nutrition
  • Disposable supplies
  • Office visits


Hospice is generally covered subject to the indications listed below and per your plan documents.

To be eligible for Hospice members must:

  1. Be terminally ill (life expectancy of six months or less), and Have chosen a plan of care focused on comfort and supportive service (palliative) and not curative care, and
  2. Be accepted by a hospice program as a participant and have signed the hospice election form, and
  3. Continue to meet the terminally ill prognosis, over the course of care.

Indications that are covered

  1. Providers must be Medicare certified.
  2. Care must be provided in accordance with an approved Hospice treatment plan. Part-time care (visit is 0- 2 hours) provided in the member's home by an interdisciplinary hospice team(which may include a physician, nurse, social worker, spiritual counselor) and other medically necessary home health services.
  3. Continuous care (2-12 hours of service per day) in member’s home or in a setting which provides day care for pain or symptom management, when medically necessary may be covered. Continuous care services may be limited, per your plan documents.
  4. Respite care is covered for care in member’s home or appropriate facility. Respite care is generally limited to 5 episodes, up to 5 days per episode.
  5. Inpatient services at a hospice facility. These services may be limited; please see your plan documents for details.
  6. Inpatient services for acute care when authorized.
    1. In patient care for an acute condition not related to the terminal illness is generally covered under the medical benefit.
    2. In patient care for acute symptom management (e.g., medication titration) related to the terminal condition is generally covered under the hospice benefit.

Indications that are not covered

  1. Residential or Inpatient hospice care beyond limits specified per your plan documents.
  2. Room and board are not covered if the member resides in a nursing home.
  3. Financial or legal counseling services.
  4. Housekeeping or meal services in the patient's home.
  5. Custodial or maintenance care related to hospice services, whether provided in the home or in a nursing home.
  6. Any services not specifically described as a covered service under the home hospice services benefit (i.e., Massage Therapy) and per your plan documents.
  7. Any services provided by members of the member’s family or residents in the member's home.
  8. Duplicate services.


Appropriate facility is a nursing home, hospice residence, or other inpatient facility.

Continuous care provides (from 2-12 hours) of service by a registered nurse, licensed practical nurse, or home health aide during a period of crisis in order to maintain a terminally ill patient at home.

Custodial care consists of supportive services focusing on activities of daily life that do not require the skills of qualified technical or professional personnel, including but not limited to, bathing, dressing and feeding. Care furnished to an individual who has elected the hospice care option is custodial only if it is not reasonable and necessary for the palliation or management of the terminal illness or related conditions.

Hospice refers to a concept of compassionate and palliative care for people in the final phase of an incurable illness. Hospice seeks neither to hasten nor postpone death. The emphasis is on quality of life by recognizing physical needs (pain control) as well as social, emotional and spiritual needs. Members may withdraw from the Hospice program at any time.

Inpatient services in a hospice facility refers to hospice care provided in hospice designated beds in a hospital, nursing home, or free-standing hospice facility.

Respite care is care in the person’s home or appropriate facility rendered to give the patient’s primary caregivers (I.e., family members or friends) rest/or relief when necessary in order to maintain a terminally ill patient at home.


This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

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Policy activity

  • 01/01/2014 - Date of origin
  • 07/31/2017 - Effective date
Review date
  • 07/2017

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