Ill. HFS Handbook for Hospice Agencies, Topic K-250.1

Routine Home Care is applicable for each day the patient (1) remains in his

residence, (2) is under the care of the hospice and (3) is not receiving continuous

home care. This rate is paid without regard to the volume or intensity of routine

home care services provided on any given day. The place of residence may be

either a private home or a long-term care facility.

Effective with dates of service on and after January 1, 2016, the Department will

reimburse routine home care on a two-tier system. Days 1 through 60 will be paid

based upon a higher rate, while days 61 and beyond will be paid at a lower rate.

For patients who have hospice elections on file on and after November 2, 2015

(within 60 days preceding January 1, 2016), the Department will look back to those

elections to calculate the initial 60 days of hospice RHC. Of the initial 60 days, only

services provided on and after January 1, 2016 will be paid at the higher rate.

The eligibility for these rates follows the patient eligibility and not the hospice

provider billed on the claims. For a hospice patient who has been discharged and

readmitted to hospice within 60 days of that discharge, the prior hospice days will

continue to follow the patient in the determination of the appropriate rate. For a

hospice patient who has been discharged from hospice care for more than 60 days,

a new election to hospice will initiate a reset of the patient’s 60-day window and the

patient will requalify for the higher rate.