CHC Minimum Hours Threshold

The CHC minimum hours threshold is the requirement that a hospice provide at least eight hours of care within a 24-hour day, more than half of it nursing, before that day can be billed as Continuous Home Care. Days below eight hours revert to the Routine Home Care rate.

Continuous Home Care is intended for brief periods of crisis, defined as a period in which a patient needs predominantly nursing care to achieve palliation or management of acute medical symptoms (42 CFR 418.204)^[1]. To bill a CHC day, the hospice must furnish a minimum of eight hours of care in a 24-hour period that runs midnight to midnight, and the hours need not be continuous, so care split across the day can aggregate to the threshold (CMS Continuous Home Care guidance)^[2]. More than half of the total care hours must be provided by a nurse (RN or LPN/LVN). CHC is paid hourly, at $69.76 per hour for FY2026, which yields a full 24-hour rate of $1,674.29, several times the RHC per diem (CMS FY2026 Hospice Wage Index final rule fact sheet)^[3]. If documented hours fall below eight, or nursing is not the majority, the day cannot be billed as CHC and is paid at RHC instead.

CHC is the highest-paying home-based level of care and among the most frequently audited, because the payment differential — up to $1,674.29 per day versus approximately $230.83 at the RHC day 1–60 rate — makes over-billing consequential. A CHC day that falls below eight documented hours or fails the majority-nursing test is repriced entirely to the RHC rate; there is no partial CHC payment for partial compliance. A CHC claim's audit defensibility depends on time-in and time-out records for each visit with discipline clearly identified, because those records are what substantiate the billed hours and the nursing-majority requirement. Claims without complete time and discipline documentation cannot support a CHC billing level.