Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-43 - Hospice Services › Subsection 144-101-II-43.07 - REIMBURSEMENT

Current through 2024-29, July 17, 2024
43.07-1
Levels of Care
Each day of care is classified into one of four levels of
						care:
1. Routine Home Care
2. Continuous Home Care
3. Inpatient Respite Care
4. General Inpatient Care
For each day a member receives hospice care, the hospice
						will be reimbursed an amount applicable to the type and intensity of the
						services provided to the member for that day. For continuous home care, payment
						is determined based on the number of hours of continuous care furnished that
						day. A description of each level of care follows.
A.
Routine Home Care
rate is
					 billed for each day the member is under the care of the hospice and not
					 receiving one of the other categories of hospice care.
In-home respite care may also be billed as Routine Home
						Care, as long as the respite providers are qualified to perform Routine Home
						Care services under this Section.
B.
Continuous Home Care
is to be
					 provided only during a period of crisis. A period of crisis is a period in
					 which a member requires continuous care which is primarily nursing care to
					 achieve palliation or management of acute medical symptoms. Nursing care must
					 be provided by either a registered nurse or licensed practical nurse, and a
					 nurse must be providing care for more than half of the period of care. A
					 minimum of eight (8) hours of care must be provided during a twenty-four (24)
					 hour day beginning at midnight. This care need not be continuous. For example,
					 four (4) hours could be provided in the morning and another four (4) hours that
					 evening. Homemaker and home health aide services may also be provided to
					 supplement the nursing care. Continuous care is covered when it is provided to
					 maintain a member 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.
Inpatient Respite Care
is a day of care in which the member
					 receives care in an approved facility for short-term respite only when
					 necessary to relieve the family members or others caring for the member at
					 home. Respite care may be provided only occasionally and may not be reimbursed
					 at the inpatient respite care rate for more than five (5) consecutive days at a
					 time. Payment for the sixth (6th) and any subsequent
					 day is at the routine home care rate.
Respite care may not be provided when the member is in a
						nursing home or any other residential facility. For in-home respite care, refer
						to Section
						43.07-1(A),
						Routine Home Care.
D.
General Inpatient Care
is a day of care when a member receives
					 general inpatient care in an inpatient facility for pain control or acute or
					 chronic symptom management which cannot be managed in other
					 settings.