MO HealthNet Hospice Provider Manual § 2.12

Hospice services are divided into four (4) basic levels of care, routine home care, continuous home care, inpatient respite, and general inpatient care. Physicians’ services and a room and board allowance are reimbursed when applicable. Reimbursement rates for the four (4) basic levels of care are consistent with the rates established by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS). Refer to Section 1 in this manual for reimbursement methodology.

A list of hospice revenue codes is located in Section 5.1 of this manual.

Routine Home Care (Revenue Code 0651)

The hospice is paid the routine home care rate for each day the participant is at home, under the care of the hospice, and not receiving continuous home care, with a higher rate for the first 60 days of hospice care and a lower rate starting on day 61. These 60 days are counted across any hospice benefit periods that are not separated by a 60-day break. The higher hospice rate would restart only if the participant had a greater than 60-day break in all hospice services. This rate is paid without regard to the volume or intensity of routine home care services provided on any given day.

CyberAccess includes a feature to allow users to view the participants’ hospice enrollment history to be able to properly count the hospice. To become a CyberAccess user, contact the Conduent Help Desk at (888) 581-9797 or CyberAccessHelpdesk@conduent.com.

Routine home care includes routine nursing service, social work, counseling services, DME, supplies, drugs, home health aide/homemakers, physical therapy, occupational therapy, and speech-language pathology therapy relating to the terminal illness.

Continuous Home Care (Revenue Code 0652)

The hospice is paid the continuous home care rate when continuous home care is needed in periods of acute medical crisis. The continuous home care rate is divided by 24 hours to arrive at an hourly rate. For every hour, or part of an hour, of continuous care furnished, the hourly rate is reimbursed to the hospice up to 24 hours a day.

Continuous home care is to be provided only during a period of acute medical crisis. A period of acute medical crisis is a period in which a participant requires continuous care, which is primarily nursing care to achieve palliation or management of acute medical symptoms. A minimum of eight (8) hours of care must be provided during a 24-hour day, which begins and ends at midnight. This care need not be continuous, e.g., four (4) hours could be provided in the morning and another four (4) hours provided in the evening of that day.

Nursing care for continuous home care must be provided by either a RN or LPN. Homemaker and aide services may also supplement the nursing care; however, a nurse must provide care for more than half of the period of care.

Continuous home care is covered when it is provided to maintain an individual at home during a medical crisis. If less skilled care is needed on a continuous basis to enable the person to remain at home, it is covered as routine home care.

Inpatient Respite Care (Revenue Code 0655)

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 (5) consecutive days per calendar month. Respite care may be provided in a MO HealthNet-certified NF, intermediate care home, or an acute care hospital.

The hospice is paid at the inpatient respite care rate for each day on which the beneficiary is in an approved inpatient, NF, or intermediate care home and is receiving respite care.

Payment for respite care may be made for a maximum of five (5) days at a time including the date of admission but not counting the date of discharge. Payment for the sixth day, and any subsequent days is made at the routine home care rate.

Respite care may not be provided when the hospice participant is a NF resident

General Inpatient Care (Revenue Code 0656)

General inpatient care is covered for periods of acute medical crisis for palliative care. Payment at the hospice inpatient care rate is made when general inpatient care is provided.

None of the other fixed payment rates (routine home care, continuous home care, or inpatient respite) are reimbursed for a day on which the participant receives hospice inpatient care except for the date of discharge. For the day of discharge from an inpatient unit, the appropriate home care rate is paid unless the participant dies as an inpatient.

When the participant is discharged deceased, the inpatient rate (general or respite) is paid for the discharge date.

Payments to a hospice for inpatient care are limited according to the number of days of inpatient care furnished to MO HealthNet participants.