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General Inpatient Care

Medicare Benefit Policy Manual (CMS Pub. 100-02) Ch. 9 §40.1.5External PDF

General inpatient care (GIP) is available to all hospice beneficiaries who are in need of pain control or symptom management that cannot be provided in any other setting. Skilled nursing care may be needed by a patient whose home support has broken down if this breakdown makes it no longer feasible to furnish needed care in the home setting.

GIP is not intended to be custodial or residential. Once a beneficiary’s symptoms are stabilized, or pain is managed, he/she must return to a routine level of care. The beneficiary may remain in a facility due to safety, but Medicare will not pay for GIP unless the beneficiary is in need of this level of care, and it is clearly documented in the medical records.

Supportive Documentation for GIP

Upon transfer to GIP level of care, documentation should include both:

  • A precipitating event (onset of uncontrolled symptoms or pain)
  • The interventions tried in the home that have been unsuccessful at controlling the symptoms

Supporting documentation for pain control may include:

  • Frequent evaluation by a doctor or nurse
  • Frequent medication adjustment
  • IVs that cannot be administered at home
  • Aggressive pain management
  • Complicated technical delivery of medication

Supporting documentation for symptom control may include:

  • Sudden deterioration requiring intensive nursing intervention
  • Uncontrolled nausea or vomiting
  • Pathological fractures
  • Open wounds requiring frequent skilled care
  • Unmanageable respiratory distress
  • New or worsening delirium

The POC should reflect the change in the level of care, the beneficiary’s response, and the collaboration with the facility staff.

Updated: 07.25.12


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