Hospice Advocates Ask White House for COVID-19 Disaster Declaration, Waivers for Hospice

Hospice industry groups are calling on the Trump Administration to allow the U.S. Centers for Medicare & Medicaid Services to relax hospice regulations in response to the COVID-19 crisis. 

The National Hospice & Palliative Care Organization (NHPCO) has asked the White House in a letter to declare the pandemic a national disaster, allowing hospices and other health care providers some flexibility in complying with Medicare Conditions of Participation. 

In addition, the National Association for Home Care & Hospice addressed a letter to CMS Administrator Seema Verma likewise asking for additional flexibility for health care providers who care for patients in the home setting. 


A disaster declaration would allow CMS to issue an 1135 waiver for health care organizations, including hospices. These waivers would relax some CMS rules regarding the timeframes for the initial and comprehensive assessments, updates to care plans, allow for contracting for core services, rules governing volunteer activities and other provisions. 

Potential CMS actions such as expanding the use of telemedicine — and ensuring providers can be reimbursed for it — could go a long way. 

“A waiver would provide a lot of flexibilities related to the conditions participation. One specific flexibility that arguably CMS could allow for, or certainly legislation could allow for, is telehealth flexibility,” NHPCO President and CEO Edo Banach told Hospice News. “You can imagine if there’s someone in a nursing facility or even at home who is in need of services, but sending someone there may be contraindicated, that the use of telehealth would be an effective, efficient, and if it can be billed that might be a real help.”


Several states have made disaster declarations related to the virus and have likewise requested a federal declaration from the White House.

Media reports suggest that the White House is taking the question of a disaster declaration into consideration. NBC News reported that the Federal Emergency Management Agency is preparing for a potential federal disaster declaration, but for now such a move remains a contingency, and the news website Politico reported that the White House is “favorably disposed” to a declaration. 

The NAHC letter to the CMS administrator requested a number of considerations for home health care and hospice providers, including allowances for expanded telehealth activity, relaxation of laboratory rules for faster processing of COVID 19 tests, and waiver of the hospice “core services” requirements to allow use of contracted staff during the pandemic period, among other provisions.

“All health care providers need to collaborate fully with [CMS] to ensure that care is provided to all those in need and to establish risk controls to prevent transmission of the virus to all extents possible,” NAHC said in the letter.

The number of COVID-19 cases continues to rise both in the United States and worldwide. The World Health Organization has declared the virus a global pandemic. To date, 938 cases have been identified in the 38 states and the District of Columbia, leading to 29 deaths, according to the U.S. Centers for Disease Control & Prevention.

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