{"ref":"MO-HSP-LOC-01","title":"Levels of Care: Routine, Continuous Home Care, Respite and General Inpatient","category":"Hospice care","summary":"Defines the four levels of hospice care (routine home care, continuous home care, inpatient respite care and general inpatient care) that every Missouri plan of care must state, the clinical criteria, orders and documentation for each, where inpatient care may be given, the Medicare limits (continuous home care of at least 8 hours in a day, respite of no more than five consecutive days, 20 percent inpatient days) and the MO HealthNet limits (at least eight hours of continuous care in 24 hours, respite limited to five days per calendar month, 20 percent inpatient days from November 1 to October 31), and how a change in level of care is decided, explained to the patient and recorded.","inShort":["Every plan of care states the level of care: routine home care, continuous home care, inpatient respite or general inpatient care.","Continuous home care is only for a crisis, to keep the patient at home. Care must be mostly nursing, at least 8 hours in the day.","Respite is a short inpatient stay so the family can rest. Medicare pays no more than five days in a row; MO HealthNet pays five days a month.","General inpatient care is for pain or symptoms that cannot be managed anywhere else. Review the need every day.","Never change the level of care without a physician order and an explanation to the patient first. Update the plan of care and tell the office the same day."],"primaryCitation":"42 CFR §418.302","citations":["19 CSR 30-35.010(2)(D)4.B","19 CSR 30-35.010(2)(D)6","19 CSR 30-35.010(1)(E)2.B","19 CSR 30-35.010(1)(F)3.G","19 CSR 30-35.010(2)(C)1.B(IV)-(V)","19 CSR 30-35.010(2)(L)2.B","19 CSR 30-35.010(2)(G)1.D(I)","19 CSR 30-35.010(2)(M)1.B(XI)-(XII)","19 CSR 30-35.020","13 CSR 70-50.010(7)(A)","13 CSR 70-50.010(7)(B)","13 CSR 70-50.010(7)(D)","13 CSR 70-50.010(8)"],"federalCitations":["42 CFR §418.302","42 CFR §418.204(a)-(b)","42 CFR §418.108","42 CFR §418.202(e)","42 CFR §418.400(b)"],"surveyorAsks":["Does this patient's plan of care state the level of care?","This patient received continuous home care. What was the period of crisis, how many hours were provided, and was the care predominantly nursing?"],"forms":[{"ref":"MO-HSP-LOC-01-A","title":"Level of Care Change Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (19 CSR 30-35.010(2)(D)4.B; 42 CFR §418.302)","5. The Four Levels of Care","6. Routine Home Care","7. Continuous Home Care","8. Inpatient Respite Care","9. General Inpatient Care","10. Where Inpatient Care Is Provided","11. Changing the Level of Care","12. Inpatient Day Limits","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"mo-hospice","state":"Missouri","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}}