Respite care

The definition centers on the caregiver. South Carolina’s developmental disabilities agency describes respite as care and supervision for people unable to care for themselves, given on a short-term basis because those who normally provide the care are absent or need relief, and says families can use it regularly or in an emergency¹. Federal rules list respite care among the services a home and community-based services waiver can include, alongside personal care, homemaker, adult day health and habilitation², and Medicaid.gov names it among the typical 1915(c) waiver services³.

Each waiver writes its own respite rules, and they can be detailed. Montana’s waiver manual says respite is only for relieving a caregiver who is not paid, that it is short-term or temporary, such as part of a day, a weekend or a vacation, and that it can be given in the member’s home, another private home, a group home, a hospital, a nursing facility or a therapeutic camp, among other settings. When a nursing facility provides it, payment generally cannot exceed that facility’s Medicaid daily rate⁴.

The billing traps follow from those rules. Respite to relieve a paid caregiver does not fit a definition like Montana’s. Respite cannot overlap other waiver services for the same hours; Montana’s own example is respite billed while the member is at adult day care⁴. And because respite is a waiver service in its own right, track its units apart from personal care hours rather than drawing both from one total.