CMS Extends Timeline for Hospice "Extraordinary Circumstances" Exemption

PUBLISHED: Oct 26, 2016

The Centers for Medicare and Medicaid Services (CMS) has announced that is extending the deadline for allowing, as a temporary measure, individual hospices to contract for nursing services until September 30, 2018.

According to CMS, some hospices may find that the current shortage of nurses is having a significant impact on access to hospice services and that hospices have had to deny services to eligible patients because they do not have adequate staff to provide nursing services.

In order to qualify for an “extraordinary circumstance” exemption, a hospice must notify the State Survey Agency (SA) responsible for licensing and certification that it intends to elect an exception under the “extraordinary circumstance” authority. This may be accomplished by providing written notification to the SA when it believes that the nursing shortage has become an "extraordinary circumstance" in its ability to hire nurses directly, and it must estimate the number of nurses that it believes it will currently need to employ under contract. Notification may be made through September 30, 2018, and should address the following:

  • An estimate of the number of patients that the agency has not been able to admit during the past three months due to the nursing shortage and the current and desired patient/nurse ratio for the agency;
  • Evidence that the hospice has made a good faith effort to hire and retain nurses, including:
  • Copies of advertisements in local newspapers and Web postings that demonstrate recruitment efforts;
  • Copies of reports of telephone contacts with potential hires, professional schools and organizations, recruiting services, etc.;
  • Job descriptions for nurse employees;
  • Evidence that salary and benefits are competitive for the area;
  • Evidence of any other recruiting activities (e.g., recruiting efforts at health fairs, educational institutions, health care facilities, and contacts with nurses at other providers in the area); and
  • Ongoing self-analyses of the hospice's trends in hiring and retaining qualified staff.

The hospice must also demonstrate that it has a training program in place to assure that contracted staff is trained in the hospice philosophy and the provision of palliative care prior to patient contact. Further, the hospice must assure that contracted staff is providing care that is consistent with the hospice philosophy and the patient's plan of care. Contracted nurses should be used to supplement the hospice nurses employed directly and should not be used solely to provide the continuous nursing level of care or on call service. Finally, the hospice is expected to continue its recruitment efforts during the period that it is contracting for nurses.

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