Hospice levels of care: criteria, documentation and FY2027 rates

The four levels at a glance

Medicare defines four hospice levels of care: routine home care, continuous home care, general inpatient care (GIP) and inpatient respite care. Routine home care applies on any day no other level is provided. The other three are short-term and each has its own qualifying need, setting and limits.

When general inpatient or respite care is needed, the hospice team confirms a contracted facility with an available bed and arranges the clinical handoff and transport before any transfer.

What are the GIP hospice criteria? (general inpatient care)

General inpatient care (GIP) qualifies when the hospice team has tried, or cannot reasonably try, to manage a symptom where the patient lives. Typical reasons are pain that needs frequent medicine adjustment and close nursing assessment, intractable nausea or vomiting, respiratory distress, uncontrolled seizures, severe agitated delirium, uncontrolled bleeding, and complex wound care that cannot be delivered at home. It is provided when medically necessary during a symptom crisis and ends when the symptom is controlled or the patient can be managed in another setting.

GIP is not for caregiver breakdown alone. That is respite. It is not custodial care, a place to wait for a nursing facility bed, or an automatic level for a patient who is imminently dying without an uncontrolled symptom. A hospital patient who elects hospice can receive GIP in the same hospital only if the hospice has a contract there and the patient has a qualifying symptom need. See the discharge planner guide.

GIP in one look

• Who decides: the hospice physician, on medical necessity, with the interdisciplinary group; the need is reassessed every day.
• Where: a Medicare-participating hospital, skilled nursing facility or hospice inpatient unit under contract with the hospice, with registered nursing available 24 hours a day.
• How long: until the symptom is controlled or the patient can be managed in another setting; each day's note states why the patient still cannot be managed elsewhere.
• What it is not: caregiver breakdown alone (that is respite), imminent death without an uncontrolled symptom, custodial care, or a place to wait for a nursing facility bed.
• When it ends: once the symptoms are controlled, the patient returns to routine home care, and the record says when and why. See the 80/20 rule for how inpatient days are counted.

What are the continuous home care (CHC) criteria?

Continuous home care qualifies during a brief period of crisis, when predominantly nursing care at the bedside is needed to keep the patient at home. The same kinds of uncontrolled symptoms that would justify GIP apply. It is provided when medically necessary during a symptom crisis. It is not a standing private-duty service and is not triggered by the family's wish for more hours alone.

The 8-hour minimum is counted within one calendar day, midnight to midnight, and the hours do not have to be consecutive. If fewer than 8 hours are provided, or nursing is not more than half, the day is paid as routine home care. In a facility, care that facility staff already provide is not counted.

What are the inpatient respite criteria?

Inpatient respite care qualifies based on the caregiver's need, not on the patient's symptoms. Examples are caregiver exhaustion, caregiver illness or surgery, or a family event. It is available up to 5 days at a time and only occasionally. It does not apply to a patient who lives in a facility where staff provide the daily care. The facility must be able to provide 24-hour nursing that meets the patient's plan of care.

Medicare hospice rates, FY2027 (October 1, 2026 to September 30, 2027)

National base rates from the FY2027 hospice final rule (CMS-1851-F) as corrected by the September 30, 2026 correction notice (CMS-1851-CN), before the local wage index adjustment. A hospice that does not report quality data has its annual update cut by 4 percentage points. These are what Medicare pays the hospice; the patient's only Medicare cost shares are up to $5 per prescription and 5% of the respite rate.

The service intensity add-on pays the continuous home care hourly rate (about $71.92), up to four hours a day, for RN and social worker visits in the last seven days of life. Source: CMS fact sheet on the FY2027 hospice final rule.

What documentation does each level of care need?

Each hospice level of care needs documentation that shows why that level was needed. For continuous home care and general inpatient care, the record should show the precipitating symptom, what was tried, and hour-by-hour or daily evidence of continued need.

Reviewers look for specifics. Vague entries such as a note that the patient is declining or is actively dying do not by themselves support a higher level of care.

How to request a change in level of care

If a hospice patient in your facility or practice has a symptom that is not controlled, call the hospice number in the patient's record. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. The nurse assesses, contacts the hospice physician, and the team decides whether a change in medicines, more visits, continuous home care or a GIP transfer is the right response. The level of care is a hospice decision made with the patient, the family and the attending physician.

For a family-readable explanation, see levels of hospice care. For eligibility for hospice itself, see the eligibility guidelines. A one-page GIP documentation checklist (PDF) carries the documentation table and the FY2027 rates for the chart.

For the rule changes that took effect in 2026 and 2027, see hospice rules 2026–2027: what changed for referrers.

Common questions about hospice levels of care