La. Admin. Code tit. 40 § I-2515

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2515 - Hospice Services Reimbursement

A. Hospice care services will be reimbursed at the lesser of covered billed charges or the per diem, per shift, or per hour rate.

1. The uniform statewide rates depicted in the table below will be applied by type of facility, either hospital based or freestanding.

2. The four categories of service are defined by the intensity of care, the skill level of the caregiver, and the place of service as follows.

a. Routine Home Care. The hospice is paid the routine home care rate for each day the patient is under the care of the hospice and not receiving one of the other categories of hospice care. This rate is paid without regard to the volume or intensity of routine home care services provided on any given day, and is also paid when the patient is receiving hospital care for a condition unrelated to their terminal condition.

b. Continuous Home Care. Continuous home care is to be provided only during a period of crisis. A period of crisis is a period in which a patient requires continuous care which is primarily nursing care to achieve management of acute medical symptoms.

i. Nursing care must be provided by either a registered nurse or a licensed practical nurse and a nurse must be providing care for more than half of the period of care.

ii. A minimum of eight hours of care must be provided during a 24 hour day which begins and ends at midnight. This care need not be continuous.

iii. 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, this is covered as routine home care.

c. Respite Care. 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 consecutive days at a time. Payment for the sixth and any subsequent days is to be made at the routine home care rate.

d. General Inpatient Care. Payment at the inpatient rate is made when general inpatient care is provided. None of the other fixed payment rates are applicable for a day on which the patient receives hospice inpatient care.

La. Admin. Code tit. 40, § I-2515

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.