Continuous Home Care provides predominately nursing care, covered for at least 8 hours and up to 24 hours in a 24 hour period, beginning and ending at midnight. Homemaker and/or hospice aide services may be covered on a 24-hour continuous basis during periods of crisis, however, the care must be predominantly nursing care.
What is Continuous Home Care?
Continuous home care (CHC) is one of the four levels of hospice care in the Medicare Hospice Benefit and required by the Medicare hospice regulations. The regulatory definition of continuous home care is meant to include predominantly nursing care, covered for at least 8 hours, and up to 24 hours in a 24 hour period, beginning and ending at midnight. Either homemaker or hospice aide services or both may be covered on a 24-hour continuous basis during periods of crisis, but the care must be predominantly nursing care. The purpose of continuous home care is to achieve palliation and management of acute medical symptoms.
When is CHC Appropriate?
Continuous home care may be provided only during a period of crisis. A period of crisis is defined by the Centers for Medicare and Medicaid Services (CMS) as a period in which a patient requires continuous EN home care, which is primarily nursing care, to achieve palliation or management of acute medical motor arom symptoms. If a patient’s caregiver has been providing a skilled level of care for the patient and the caregiver is unwilling or unable to continue providing care, this may precipitate a period of crisis because the skills of a nurse may be needed to replace the services that had been provided by the caregiver. (CMS, Chapter 9 – Coverage of Hospice Services Under Hospital Insurance, 2011) CMS provides examples of circumstances that may qualify as CHC in the Medicare Benefit Policy Manual; Chapter 9 – Coverage of Hospice Services under Hospital Insurance.
Where Can CHC Be Provided?
CHC can be provided in the place where a patient resides such as:
- A private residence
- An Assisted Living Facility
- A long term care facility (LTC) or non-skilled nursing facility (NF) (if the patient is not receiving a skilled level of care, i.e. Medicare Part A skilled benefit)
- Providers need to be aware of how nursing facilities are licensed in their state as this will impact location of care codes on the hospice claim form. For example, all nursing facilities in Connecticut and New York are licensed as skilled nursing facilities.
- This location of care would be coded on the claim form as Q5003, Hospice care provided in a nursing long term care facility (LTC) or non-skilled nursing facility (NF)
- A hospice facility if the patient is not receiving a general inpatient level of care