CMS Waives Hospice Rules During Pandemic, Further Expands Telehealth

The U.S. Centers for Medicare & Medicaid Services (CMS) has waived a number of hospice regulations, including temporarily removing the requirement that a nurse conduct a home visit at least every two weeks and expanding the allowable use of telehealth.

These flexibilities for hospice are components of a larger initiative intended to reduce regulatory burden across the health care continuum as providers battle through the ongoing COVID-19 pandemic.

“Every day, heroic nurses, doctors, and other health care workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients,” said CMS Administrator Seema Verma. “Front line health care providers need to be able to focus on patient care in the most flexible and innovative ways possible. This unprecedented temporary relaxation in regulation will help the health care system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly.”


CMS has suspended the requirement that a hospice nurse visit a patient’s location at least once every two weeks. The waiver also applies to the rule requiring a nurse to conduct an onsite visit to evaluate whether aides are providing care consistent with the patient’s care plan. Further, the agency has waived the requirement that volunteers provide 5% of patient care hours and extended the timeframe for updating a patient’s comprehensive assessment to 21 days.

The agency will also allow hospice clinicians to conduct visits and provide services via telehealth as long as those activities are consistent with the patient’s plan of care.

Less clear is whether physicians can certify patients for hospice via telehealth. In a Monday night conference call with media outlets CMS officials said they would have to look into that question. Physicians are able re-certify patients using telehealth, however, following the recent adoption of the CARES Act.


While most hospice providers will welcome the expanded use of telehealth in their efforts to protect staff, patients and families from the novel coronavirus, many of them may have concerns regarding CMS payment for those services.

“Hospices are paid an all-inclusive rate. CMS has said that we’re free to make visits utilizing telehealth, but we are not free to include those visits in the cost reports or separately bill for them,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “The problem is that if you can’t put that visit on the cost report, and it doesn’t get to be used for quality reporting, and it doesn’t get separately paid for, then that removes some of the flexibility for hospices.”

Further complicating the telehealth question is the consideration that the Medicare Payment Advisory Commission uses cost report data to develop its recommendations for future hospice payment rates.

“If we go through a whole year where a number of providers have either been unable to make visits or, as a public health measure, have made more visits via telehealth — and those visits aren’t reflected in the cost reports — that may be very concerning,” Banach said.

These flexibilities introduced by CMS are temporary and would end after the federal declaration of a national emergency is lifted.

To date, more than 140,000 people in the United States are known to have acquired COVID-19, leading to more than 2,400 deaths, according to the U.S. Centers for Disease Control & Prevention.

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