CMS Relaxes Hospice Training Rules

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued additional 1135 waivers for hospice, pertaining to training requirements for hospice aides. 

CMS can issue an 1135 waiver for health care organizations during a federally declared national emergency. These waivers temporarily suspend or modify Medicare Conditions of Participation (CoPs) and other requirements to allow providers to focus their efforts on caring for a potentially massive influx of patients. These considerations are temporary and expire when the national emergency is officially concluded.

“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”


Among the new waivers, CMS is allowing hospices to use “pseudo patients,” meaning an individual who stands in the role of a patient or a computerized mannequin device, during competency tests for hospice aides, rather than requiring contact with actual patients as typically required under the CoPs.

CMS has also suspended the requirement that hospice aides undergo a mandatory 12 hours of in-service training annually. Hospice nurses typically conduct this training and the waiver allows both nurses and aides to focus on patient care rather than these requirements.

Part of the goal for these waivers is to allow clinicians to practice at the full scope of their licenses, leveraging their experience and expertise to maximize the quality and quantity of patient care.


“We have this outdated way of dealing with professions in Medicare, where at the very top of the food chain are physicians, and then you have nurses who work under their supervision, and then you have aides who operate under the supervision of the nurses,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization, told Hospice News. “The thing we need to think about, especially in the context of a pandemic, but I think after that, especially as hospices deal with work shortages, is that it’s a bit paternalistic to require all of these levels of supervision. If there’s a problem or a compliance issue, then sure, absolutely, but we do need to better utilize the resources that we have.”

CMS previously issued waivers to suspend the requirement that a hospice nurse visit a patient’s location at least once every two weeks to evaluate care provided by aides. The agency has also waived the rule that volunteers provide 5% of patient care hours and extended the timeframe for updating a patient’s comprehensive assessment to 21 days, in addition to expanding allowable use of telehealth for routine home care and recertification of patients for hospice.

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