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 not be reimbursed for more than five consecutive days at a time, including the date of admission but not including the date of discharge. More than one respite period (of no more than 5 days each) is allowable in a single billing period (CMS, Chapter 11, Sec 30.1, 2011) There is no written guidance from the Centers for Medicare & Medicaid Services (CMS) which restricts the use of respite to one time per benefit period.
Where Can Respite Care be Provided ?
- A Medicare-certified inpatient hospice facility
- A contracted Medicare-certified hospital or a skilled nursing facility that has the capability to provide 24-hour nursing if the patient’s plan of care required that type of nursing intervention.
When is Respite Care Appropriate?
Respite care is for short term caregiver relief, so there needs to be a caregiver involved in the patient’s care. The Centers for Medicare and Medicaid Services (CMS) does not furnish a list of scenarios or examples appropriate for respite care, so it is at the hospice provider’s discretion to determine the merit of the caregiver’s need. Some examples for provision of respite care may include:
- The caregiver is physically and emotionally exhausted from caring 24/7 for the patient and requires a break.
- The caregiver would like to attend a family event, such as a wedding, graduation, or other event.
- The caregiver is ill and needs a break from patient care to recover.