Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 25 - Hospital Reimbursement Schedule, Billing Instruction and Maintenance Procedures
Section I-2515 - Hospice Services Reimbursement
Universal Citation: LA Admin Code I-2515
Current through Register Vol. 50, No. 9, September 20, 2024
A. Hospice care services will be reimbursed at the lesser of covered billed charges or the per diem, per shift, or per hour rate.
1. The uniform statewide rates depicted
in the table below will be applied by type of facility, either hospital based
or freestanding.
2. The four
categories of service are defined by the intensity of care, the skill level of
the caregiver, and the place of service as follows.
a. Routine Home Care. The hospice is paid the
routine home care rate for each day the patient is under the care of the
hospice and not receiving one of the other categories of hospice care. This
rate is paid without regard to the volume or intensity of routine home care
services provided on any given day, and is also paid when the patient is
receiving hospital care for a condition unrelated to their terminal
condition.
b. Continuous Home Care.
Continuous home care is to be provided only during a period of crisis. A period
of crisis is a period in which a patient requires continuous care which is
primarily nursing care to achieve management of acute medical symptoms.
i. Nursing care must be provided by either a
registered nurse or a licensed practical nurse and a nurse must be providing
care for more than half of the period of care.
ii. A minimum of eight hours of care must be
provided during a 24 hour day which begins and ends at midnight. This care need
not be continuous.
iii. Continuous
home care is covered when it is provided to maintain an individual 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. Respite Care.
Respite care is short-term inpatient care provided to the individual only when
necessary to relieve the family members or other persons caring for the
individual at home. Respite care may be provided only on an occasional basis
and may not be reimbursed for more than five consecutive days at a time.
Payment for the sixth and any subsequent days is to be made at the routine home
care rate.
d. General Inpatient
Care. Payment at the inpatient rate is made when general inpatient care is
provided. None of the other fixed payment rates are applicable for a day on
which the patient receives hospice inpatient care.
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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