Ind. IHCP Hospice Services Provider Reference Module, Section 1, Continuous Home Hospice Care

Hospice providers should follow the parameters for continuous home hospice care outlined in Chapter 9,

Section 40.2.1, of the Medicare Benefit Policy Manual.

Continuous home hospice care can be provided during a period of crisis to maintain the individual at home.

A period of crisis is defined as a time in which the patient requires predominantly nursing care to achieve

palliation or management of acute medical symptoms. For example, if a caregiver has been providing

skilled nursing care and becomes unable or unwilling to continue providing the care, this development may

precipitate a period of crisis, because the skills of a nurse may be required to replace the services that had

been provided by the caregiver.

Under the continuous home hospice care level of service, the hospice must provide a minimum of eight hours

of primarily nursing care during a 24-hour day:

• The 24-hour day begins and ends at midnight.

• The care need not be continuous. This means care can be provided in smaller increments that add up

to a total of eight hours within that 24-hour day.

• Nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN) must be

provided for at least half of the period of care:

➢ The skilled care provided by the nurse may be supplemented by a home health aide.

➢ If the majority of the care can be accomplished by a home health aide, the care rendered would

be covered as a routine home hospice care day.

• When fewer than eight hours of care are provided, the care is reimbursed at the routine home care

rate.

Documentation should clearly indicate the nature of the medical crisis and the need for skilled intervention,

and illustrate, hourly and daily, the level of staffing and the services that were provided.