Section 1130.63. Limitations on coverage

(a) Nursing care may be covered on a continuous basis for as much as 24 hours a day during periods of crisis as necessary to maintain the recipient at home. Homemaker or home health aide services, or both, may be covered on a 24-hour continuous basis during periods of crisis, but care during these periods shall be predominantly nursing care as described by Medicare regulations at 42 CFR 418.202(a) (relating to covered services).

(b) Respite care may not exceed a total of 5 days in a 60-day certification period.

(c) Bereavement counseling is a required hospice service but it is not reimbursable.

(d) General inpatient care shall be provided in a general hospital, skilled nursing facility or a freestanding hospice participating in the MA Program.

(e) An intermediate care facility may provide only respite care services to the hospice. Eligible MA recipients residing in an intermediate care facility may elect to receive care from a participating hospice.

(f) Hospice providers may arrange for respite care services only in those intermediate care facilities that meet the Medicare regulations at 42 CFR 418.100(a) and (f) (relating to condition of participation for freestanding hospices providing inpatient care directly) regarding 24-hour nursing services and patient areas.