Hospice Levels of Care: Continuous Home Care

There are four levels of care in the Medicare Hospice benefit. Hospices are paid a per diem rate based on the number of days and level of care provided during the election period. The four levels of care are RHC, CHC, inpatient respite care, and GIP. This job aid will focus on the continuous home care, or CHC, level of care. See the Related Content section for links to information on all of the levels of care.

Continuous Home Care

CHC is provided only during a period of crisis, and it is covered only as necessary to maintain the hospice patient at home. A period of crisis is a period in which a patient requires continuous care, which is primarily nursing care, to achieve palliation or management of acute medical symptoms. Continuous home care is not intended to be used as respite care.

The hospice must provide a minimum of eight hours of care during a 24-hour day, which begins and ends at midnight. This care does not have to be continuous. For example, four hours could be provided in the morning and another four hours in the evening. When fewer than eight hours of care are required, the services are covered as routine home care rather than continuous home care. Nursing care must be provided for more than half of the period of care, and the nursing care must be provided by an RN, LPN, LVN, or NP. Homemaker or hospice aide services may be provided to supplement the nursing care.

Note: Services provided by a nurse practitioner that, in the absence of a nurse practitioner, would be performed by an RN, LPN, or LVN, are nursing services and are paid at the same continuous home care rate.

The computation of the required eight hours for the CHC level of care applies only to direct patient care provided by a nurse, a homemaker, or a hospice aide. If the patient’s needs require direct interventions by more than one covered discipline resulting in an overlapping of hours between the nurse and hospice aide, the overlapping hours would be counted separately. The hospice would need to ensure that these direct patient care services are clearly documented and are reasonable and necessary.

All nursing and aide hours should be included in the computation for CHC. If the aide hours exceed the nursing hours, the nursing time requirement would not be met, and therefore, CHC would not be the appropriate level of care. Instead, the routine level of care would need to be reported.

Billing

The CHC level of care is reported with revenue code 0652. The amount of payment is determined based on the number of hours, reported in increments of 15 minutes (rounded to the nearest increment), of continuous care furnished to the patient on that day. Below is a time reporting chart to assist in determining the correct number of units to report with the CHC level of care.

Time Reporting Chart for CHC Units (1 unit=15 minutes)

Units	Length of Time (hours)	Units	Length of Time (hours)
32	8	65	16.25
33	8.25	66	16.5
34	8.5	67	16.75
35	8.75	68	17
36	9	69	17.25
37	9.25	70	17.5
38	9.5	71	17.75
39	9.75	72	18
40	10	73	18.25
41	10.25	74	18.5
42	10.5	75	18.75
43	10.75	76	19
44	11	77	19.25
45	11.25	78	19.5
46	11.5	79	19.75
47	11.75	80	20
48	12	81	20.25
49	12.25	82	20.5
50	12.5	83	20.75
51	12.75	84	21
52	13	85	21.25
53	13.25	86	21.5
54	13.5	87	21.75
55	13.75	88	22
56	14	89	22.25
57	14.25	90	22.5
58	14.5	91	22.75
59	14.75	92	23
60	15	93	23.25
61	15.25	94	23.5
62	15.5	95	23.75
63	15.75	96	24
64	16