Complete Story
12/07/2021
You Asked... We Answered 12/7/21
You Asked:
I was reading the Ohio rules for hospice. The inpatient respite length of stay stood out to me. Ohio law states no more than seven consecutive days, where I understood respite to be no more than five nights and on day six would be paid at the routine homecare rate. Has something changed?
We Answered:
No, nothing has changed. Ohio Medicaid has always allowed a family seven days of respite care for hospice to give temporary relief to a hospice patient's family or other caregivers when the patient's family or other caregiver needs relief from the daily demands of caring for the patient, hence the Ohio Department of Health (ODH) rules reflect the seven-day consecutive limit.
Medicare has a limit of five days when necessary to relieve the family members or other persons who normally care for the individual at home. Please see the Ohio rule at this link that speaks to respite stays as well as the Hospice Medicare Claims Processing Manual Chapter 11 that speaks to the timeframe for respite for Medicare recipients.
30.1 - Levels of Care Data Required on the Institutional Claim to A/B MAC
Inpatient Respite Care - The hospice is paid at the inpatient respite care rate for each day on which the beneficiary is in an approved inpatient facility and is receiving respite care. 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. If the beneficiary dies under inpatient respite care, the day of death is paid at the inpatient respite care rate. Payment at the respite rate is made when respite care is provided at a Medicare or Medicaid certified hospital, SNF, hospice facility, or NF.