The blanket waivers issued by the Centers for Medicare and Medicaid Services (CMS) did not directly address the critical role performed by hospice providers in delivering compassionate palliative care during this national public health emergency. In addition to clarifying that hospice providers are specifically included in the categories of providers to which the blanket waivers apply, we ask that CMS afford these providers with additional flexibility to confront the challenges caused by COVID-19 through the following waiver requests:
- Suspending all face-to-face visit requirements by hospice physicians and nurse practitioners in favor of permitted telephone and telehealth modalities (42 C.F.R. §418.22(a)(4))
- Extending the five-day timeframe for hospice providers to submit Notices of Election and Notices of Termination/Revocation (42 C.F.R. § 418.24)
- Encouraging all included hospice services to be provided virtually through telephone and telehealth modalities as determined by the hospice plan of care, including visits from all hospice disciplines, including nursing, social worker, spiritual services, bereavement and other counseling, and any other type of service specified in the plan of care
- Temporarily suspending the requirement of supervision of hospice aides by a registered nurse every 14 days for hospice agencies (42 C.F.R. § 418.76)
- Suspending the requirement that hospices conduct background checks on employees with direct patient contact or access to records before hiring them, such that employees can be onboarded while the background check is processed (42 C.F.R. § 418.113)
- Suspending the volunteer requirements to reflect that many hospice volunteers, who tend to be elderly themselves, are not visiting patients and respecting limitations on social interaction (42 C.F.R. § 418.78(b))
- Limiting the provision of rehabilitative services, including physical therapy, occupational therapy, and speech therapy as these services tend to be limited in hospice care generally, workforce challenges are becoming more acute, and the suspension of these services will serve to respect calls for limited social interaction.
- Delay the implementation of the hospice election statement changes and the hospice election statement addendum, scheduled to begin on October 1, 2020 until two months after the national emergency is concluded.
This is known as the glaring omission waiver.