Ga. Medicaid Part II Policies & Procedures for Hospice Services § 1003

There are four levels of care into which each day of care is classified for reimbursement of the

Medicaid Only member:

1003.1. Routine Home Care

1003.2. Continuous Home Care

1003.3. Inpatient Respite Care

1003.4. General Inpatient Care

1003.5. For each day that an individual is under the care of a hospice, the hospice will be

reimbursed an amount applicable to the type and intensity of the four (4) levels of care

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. A description of each level of care follows:

1003.5.1. Routine Home Care

The hospice will be paid the routine home care rate for each day the

patient is at home under the care of the hospice, including patients

residing in a nursing home. The per diem rate is paid based on the

hospice’s Plan of Care for the patient rather than the volume or intensity

of routine home care services on any given day.

1003.5.2. Continuous Home Care

The hospice will be paid the continuous home care rate when continuous

home care is provided. Continuous home care is to be provided only

during a period of crisis (see sections 905 and 906). The continuous

home care rate is divided by 24 hours to yield an hourly rate and each

hour billed is billed as one unit. The 24-hour day begins and ends at

midnight. A minimum of 8 hours of care must be provided to qualify for

continuous home care rates. This care need not be consecutive, i.e., 4

hours could be provided in the morning and another 4 hours provided in

the evening of that day; however, same date of service combined units

(8) must be billed on one detail line. Three (3) 8-24-hour days are

allowed per calendar month. For every hour or part of an hour of

continuous care furnished, the hourly rate will be reimbursed to the

hospice up to a maximum of 24 hours and only as necessary to maintain

the terminally ill patient at home. The hospice payment on a continuous

care day varies depending on the number of hours (units) of continuous

services provided.

1003.5.3. Inpatient Respite Care

The hospice will be paid at the inpatient respite care rate for each day on

which the beneficiary is in an approved inpatient facility and is receiving

respite care. Payment for respite care may be made for a maximum of 5

days at a time including the date of admission but not counting the date

of discharge. Payment for the sixth and any subsequent days is to be

made at the routine home care rate.

1003.5.4. General Inpatient Care

Payment at the inpatient rate will be made when general inpatient care is

provided for services related to the terminal illness. (See Section 903.5.)

None of the other fixed payment rates (i.e., routine home care) will be

applicable for a day on which the patient receives hospice inpatient care

except as described in Section 1002.5.

NOTE: Inpatient Care (General or Respite) and Nursing Home Room

and Board cannot be reimbursed for the same member for the same

covered days of service.

1003.6. Date of Discharge

For the day of discharge, the appropriate home care rate is to be paid for the day of

discharge from an inpatient unit unless the patient dies as an inpatient. If the patient is

discharged deceased, the inpatient rate (general or respite) is to be paid for the

discharge date.