Del. Medical Assistance Program Hospice Provider Specific Policy Manual § 3.3

3.3.1 Reimbursement for Hospice care will be made at one of four predetermined

rates. For each day that an individual is under the care of a hospice, DMAP will

pay the hospice an amount applicable to the type and intensity of the services

furnished to the individual for that day. For continuous home care, the amount of

payment is determined based on the number of hours of continuous care

furnished to the beneficiary on that day. There are four levels of care into which

each day of care is classified; a description of each level of care follows:

A. Routine Home Care - The hospice is paid the routine home care rate for each

day the patient is under the care of the hospice when no other level of care

applies. This rate is paid without regard to the volume or intensity of services

provided on any given day.

B. Continuous Home Care –The hospice is paid the continuous home care rate

when continuous home care is provided. The continuous home care rate is

divided by 24 hours in order to arrive at an hourly rate. A minimum of 8 hours

per day must be provided. The hospice will be paid for every hour or part of

an hour of continuous care furnished up to a maximum of 24 hours a day.

C. Inpatient Respite Care - The hospice will be paid the inpatient respite care

rate for each day the beneficiary is in an approved inpatient facility and is

receiving respite care. Respite care is paid for a maximum of 5 days at a time

including the date of admission but not counting the date of discharge. Pay

for the sixth and any subsequent days at the routine home care rate.

D. General Inpatient Care - DMAP will pay at the general inpatient rate when

general inpatient care is provided except as described in section 3.4 of this

manual. General Inpatient Care means short-term, general inpatient care

provided either through an appropriately certified hospital or hospice inpatient

facility to provide pain control and symptom management that cannot be

accomplished in another setting.