Ga. Medicaid Part II Policies & Procedures for Hospice Services § 906

906.1. Continuous Care is a continuous home care day on which an individual who has elected

to receive hospice care in his/her own home (including a nursing facility in which the

individual resides) requires continuous “around the clock” nursing care. Continuous

Home Care is to be provided only during a period of crisis and only as necessary to

maintain the terminally ill patient at home. The crisis is managed by primarily

providing nursing care to the patient to achieve palliation or management of acute

medical symptoms.

NOTE: A nursing facility must immediately notify the hospice if clinical complications,

i.e. acute medical symptoms, appear that suggest a need to alter the plan of care and

must document notification to the hospice of the need for continuous care in the patient

file.

906.2. Types of symptoms that might require continuous nursing care at home or while in the

nursing facility may include uncontrolled:

906.2.1. Severe pain

906.2.2. Nausea and vomiting

906.2.3. "Terminal restlessness" or agitation

906.2.4. Bleeding

906.2.5. Acute respiratory distress

906.2.6. Frequent medication adjustment to control symptoms

906.2.7. Symptom management/rapid deterioration/imminent death

Nursing care may be covered on a continuous basis for a maximum of 24 hours a day

during periods of crisis to prevent hospitalization or inpatient hospice care. The 24-hour

day begins and ends at midnight. A minimum of 8 hours of care per 24-hour day must

be warranted to qualify for Continuous Care. The 8 hours of 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.

Nursing care must be provided by either a registered nurse or a licensed practical nurse

and a nurse must be providing care for more than half or over 50% of the period of care

each day. Homemaker and aide services may also be provided to supplement the

nursing care for less than half of the period of care.

Continuous nursing care needs for the patient must be re-evaluated at the end of each

qualified period of 8 to 24 hours. The qualified hours per month may total up to 72

hours within a maximum of 3 days per calendar month.

During continuous home care, all progress notes must substantiate the nursing care and

supplemental staff hours for all hours billed. If less skilled care is needed on a

continuous basis to enable the person to remain at home, this is covered as routine home

care.

Supporting documentation by all hospice staff is required to remain on patient file.

906.3. Respite Care is short-term inpatient care provided to the individual only when

necessary to relieve the family members or other persons caring for the individual at

home. Respite care may be provided only on an occasional basis and may not be

reimbursed for more than five consecutive days at a time. Respite care may not be

provided when the hospice patient is residing in a nursing home on a permanent basis.

906.4. Bereavement Counseling consists of counseling services provided to the individual’s

family after the individual’s death. Bereavement counseling is a required hospice

service, but it is not reimbursable.