Terminally Ill Military Kids Can Now Receive Both Treatment and Hospice

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A policy change, ordered by the 2018 NDAA, will allow military dependents under 21 to receive both medical treatment for their terminal illness and care that falls under the umbrella of "hospice." (U.S. Army/ Sgt. Ian Valley)
A policy change, ordered by the 2018 NDAA, will allow military dependents under 21 to receive both medical treatment for their terminal illness and care that falls under the umbrella of "hospice." (U.S. Army/ Sgt. Ian Valley)

The parents of children with terminal illnesses covered by Tricare no longer have to choose between treatment and end-of-life care, thanks to a policy update issued today.

The policy change, ordered by the 2018 National Defense Authorization Act (NDAA), will allow military dependents under 21 to receive both medical treatment for their terminal illness, such as medication, radiation or surgeries; and care that falls under the umbrella of "hospice," which includes pain relief and symptom control. Under previous law and policy, a patient could only receive one or the other.

While the either-or policy might work for adults whose terminal illnesses lead to predictable declines, studies have shown that integrating hospice with ongoing recovery treatments can actually increase sick kids' chances of survival, advocates said.

"Hospice" is an umbrella service category that is further broken down into three types: concurrent curative, palliative and standard hospice. Concurrent curative care combines standard end-of-life care with life-prolonging treatments. Palliative care is offered after a serious diagnosis to give both symptom management and end-of-life counseling with potentially life-saving medical care.

The Affordable Care Act (ACA) in 2010 required Medicaid and private insurers to allow the care to be paired. But Tricare was exempt from that law, and advocates lobbied an additional seven years to push Tricare to follow suit. The 2018 NDAA enacted that change, and the policy update issued today lays out the path for using it.

"The Tricare for Kids Coalition is dedicated to ensuring that the 2.4 million children of military families receive the 'right care, at the right time, with the right provider, in the right setting,'" Kara Tollett Oakley, an advocate who founded the coalition which helped lobby for the change, told Military.com in a statement. "The policy manual implementation today ... is a big step toward that goal. We are thrilled that our military families no longer must make the untenable choice to remove their child from a course of treatment in order to receive hospice care."

Advocates with the National Military Family Association, which also lobbied for the change, said they expect the change to have an immediate impact on the quality of life of terminally ill military kids.

"We appreciated Congress listed to us and addressed this issue in the FY18 NDAA," Karen Ruedisueli, a deputy director for government policy with the organization said in a statement.

The Tricare policy blocking patients from receiving both hospice care and illness treatment remains in effect for patients over age 21.

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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