Updated regulations, as a result of a lawsuit against CMS, provide a distinctive change for patients who are in need of continued home care services. The definition of home care services under the regulation, however, is restrictive. The regulations state that skilled nursing must be the predominant service provided to the patient in a ‘crisis’ based situation. Patients who reside in senior living communities are also allowed to have continuous service, as a senior living community is defined as the patient’s home. However, if the patient resides in a skilled nursing facility (SNF), continuous home care will not be allowed as the SNF should already be providing this care.
Below is the first portion of the summary. To gain a better understanding, we recommend you review the CMS manual (Medicare Benefit Policy Manual Chapter 9 – Coverage of Hospice Services Under Hospital Insurance) for examples and situations. An excerpt from the manual is below:
40.2.1 – Continuous Home Care (CHC)
(Rev. 188, Issued: 05-01-14; Effective: 08-04-14; Implementation: 08-04-14)
Continuous home care may be provided only during a period of crisis as necessary to maintain an individual at home. A period of crisis is a period in which a patient requires continuous care which is predominantly nursing care to achieve palliation or management of acute medical symptoms. If a patient’s caregiver has been providing a skilled level of care for the patient and the caregiver is unwilling or unable to continue providing care, this may precipitate a period of crisis because the skills of a nurse may be needed to replace the services that had been provided by the caregiver. This type of care can also be given when a patient resides in a long term care facility. However, Medicare regulations do not permit CHC to be provided in an inpatient facility (a hospice inpatient unit, a hospital, or SNF).
To Access the full text with examples and possible situations, follow this link:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf