{"ref":"MI-HSP-LOC-01","title":"Levels of Care: Routine Home Care, Continuous Home Care, Respite and General Inpatient Care","category":"Hospice care","summary":"Sets out the four levels of hospice care that Michigan law and Medicare recognize (routine home care, continuous home care, inpatient respite care and general inpatient care): when each is used, who orders it, where it is given, how it is documented and reviewed, the 8-hour minimum for continuous home care, the 5-consecutive-day limit for respite, the Medicare 20 percent inpatient limit, the service intensity add-on in the last 7 days of life, the Michigan Medicaid rules on hospital care related to the terminal illness, and the rule that a level of care is chosen only by the patient's clinical need.","inShort":["There are four levels of care: routine home care, continuous home care, inpatient respite and general inpatient care. Only the patient's needs decide the level.","Continuous home care is for a short medical crisis, to keep the patient at home. It must be mostly nursing care and at least 8 hours on a day.","Respite gives the caregiver a rest in an approved facility, for no more than 5 days in a row at a time.","General inpatient care is for pain or symptoms that cannot be managed anywhere else. A nurse reviews the patient every day.","Every change needs a physician's order, the patient's agreement and a plan of care update the same day. Tell the team, the facility and billing the same day."],"primaryCitation":"42 CFR §418.302","citations":["MCL 333.21401(1)(a), (c)","MCL 333.21415","Mich. Admin. Code R 325.45345(1)(h)","Mich. Admin. Code R 325.45353(3)","Mich. Admin. Code R 325.45349","Mich. Admin. Code R 325.45199","Michigan Medicaid Provider Manual, Hospice, Sections 3.4, 4.3, 6.5, 6.6 and 7.3"],"federalCitations":["42 CFR §418.302","42 CFR §418.204","42 CFR §418.108","42 CFR §418.202(e)","42 CFR §418.110(b)","42 CFR §418.400(b)","42 CFR §418.56(d)"],"surveyorAsks":["Show me the order and the hourly notes for this patient's continuous home care. Was the care predominantly nursing care?","Why was this patient on general inpatient care, and how did your staff review the need each day?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.302)","5. The Four Levels at a Glance","6. Routine Home Care","7. Continuous Home Care","8. Inpatient Respite Care","9. General Inpatient Care","10. Where Inpatient Care Is Given","11. Changing the Level of Care","12. Medicare Inpatient Days Limit","13. Billing the Level of Care","14. Responsibilities","15. Records and Compliance Monitoring","16. Staff Training","17. References","18. Related Policies and Forms","19. Approval","20. Revision History"],"version":"1.0","sample":false,"pack":"mi-hospice","state":"Michigan","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}