Of the 115,000 persons involved in hospice care in America, some 95,000 are volunteers. Each year volunteers give more than 5 million hours to helping dying persons and their families.

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Levels of Insurance Reimbursable For Hospice Care

Generally, Medicare and Medicaid will cover four (4) levels of care, provided that sufficient documentation can be provided.  However, it is important to note that most private pay insurance will only cover one (1) level of care.

Routine Home Care – This level of care is the most common since this is the normal day-to-day care.  Most insurance policies will cover this level of care.  Routine home care is covered regardless of the volume or intensity of services provided on any given day.  Routine home care includes the following situations:

  • If the patient enters into the hospital for an unrelated condition.
  • If the patient is in a hospital that is not contracted with the hospice.
  • If the patient is receiving outpatient services in the hospital, or for the day the patient is discharged alive from GIP (general inpatient care) or respite level of care.

Continuous Home Care – Medicare and Medicaid will cover this service during a period of crisis.  A crisis is defined as a period of time in which the patient requires predominately nursing care to achieve palliation of management of acute medical symptoms.  This level of care generally is only allowed for a 24 hour period.  It is important to note that a patient who is actively dying would not be considered in crisis and would not automatically qualify for the continuous level of care.  If after a 24 hour period, palliation of symptoms is not achieved the patient may be moved to a General Inpatient level of care.

Inpatient Respite Care – This is a benefit of Medicare and Medicaid, but most private pay insurance policies will not cover this type of care.  Respite care must be provided in a participating hospice inpatient unit, participating hospital or SNF, NF, or INF.  Inpatient Respite Care is reimbursable when the primary caregiver for the patient needs respite or relief.  Medicare/Medicaid Respite Care is limited to five (5) days per certification period.  Most private pay insurance policies do not provide for this service and patients with Medicare could be responsible for a 5% co-payment.  However, Hospice of Leesville will pay the patients 5% co pay when on our services.

When a patient is admitted to a participating facility for respite care the hospice agency maintains supervision of and responsibility of patient.  Social work/case management, chaplaincy, nursing aide services and nursing supervision of patient will be provided by Hospice of Leesville. The hospice physician does not make rounds on a respite care level patient.  This is not an acute patient care situation therefore the hospice agency provides wheel chair or other transportable DME’s as already provided for in the patients home setting (not including hospital bed). The patient provides his or her medications from home and takes medications as prescribed.

The Medicare/Medicaid benefit requires the participating hospital, SNF, NF, or INF to provide only room and board and assistance with medications if patient is unable to attend to him or herself.

General Inpatient Care – The final level of care a patient might enter into is General Inpatient care.  This care is provided in a participating hospice inpatient unit, participating hospital, SNF or NF.  General inpatient care is for care related to the terminal illness.  General Inpatient care is not acute care treatment.  This level of care would be appropriate when a patient requires pain control or acute/chronic symptom management which cannot be performed in another setting.  In addition, this level of care would be appropriate if home support has been broken down and the breakdown makes it impossible or unfeasible to keep the patient at home.  Examples of situations appropriate for this level of care might include stabilizing treatment or when a patient’s family is unwilling to permit the needed care to be furnished in the home.  General Inpatient Care is not intended to be a permanent solution (usually 14 days or less).  This level of care is not a benefit offered by most private pay insurance.  However, if the patient is general inpatient, the admitting hospice is responsible for the agreed contracted fee.

When a hospice patient is moved to a General Inpatient setting in a participating hospital, SNF of NF the hospice agency maintains responsibility for the management of the patients care including :

  • Physician rounds
  • Social work/case management
  • Chaplaincy
  • Daily nursing visits and supervision of care 

The participating facility is responsible for:

  • Providing room and board
  • Medications
  • Recording vital signs 1 time per shift
  • Providing patient hygiene
  • Providing needed equipment