You Asked:
For Ohio, are hospices required to provide 24-hour nursing coverage to our hospice patients when they are in respite? The Centers for Medicare & Medicaid Services (CMS) states a respite level of care up to five consecutive days can be provided more than once in a billing cycle. If a patient’s caregiver receives their five-day respite stay on 11/15 through 11/19 and shows a need again on 12/1 through 12/4, would this be acceptable?
We Answered:
The Medicare conditions of participation no longer require 24-hour nursing coverage for a respite level of care if the respite bed is contracted with a nursing facility. The revised regulatory citation at 418.108(b)(2) states that 24-hour nursing should meet the nursing needs of all patients and furnished in accordance with each patient’s plan of care. The contracted nursing facility would provide room and board services and function as the patient’s caregiver during the respite stay.
The respite scenario you suggested above would qualify for two billable respite stays if the hospice documented the patient’s caregiver had a need for the respite stays. The Medicare Hospice Claims Manual Chapter 11 states: “Payment for respite care may be made for a maximum of 5 continuous days at a time including the date of admission but not counting the date of discharge. Payment for the sixth and any subsequent days is to be made at the routine home care rate. More than one respite period (of no more than 5 days each) is allowable in a single billing period.”