CMS Issues New 1135 Waivers for Hospice Training,Won’t Pay for Telehealth

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued new 1135 waivers that temporarily release hospices from having to comply with certain requirements related to training. The agency also indicated that for the time being hospices cannot bill CMS for telehealth visits or include those visits on their cost reports. 

For the duration of the COVID-19 national emergency declaration, hospices are exempt from requiring a registered nurse or other skilled professional to make an annual, onsite supervisory visit for each aide. As with all 1135 waivers, hospices will have to resume compliance with these rules after the federal disaster declaration expires.

CMS is also modifying the requirement mandating that hospice annually assess the skills and competence of all individuals furnishing care, and to provide in-service training and education programs where required.


“We are postponing the deadline for completing this requirement throughout the COVID-19 [public health emergency (PHE)] until the end of the first full quarter after the declaration of the PHE concludes. This does not alter the minimum personnel requirements,” the agency indicated in a statement.

CMS is also permitting hospices to narrow the scope of their required Quality Assurance and Performance Improvement (QAPI) programs to focus on infection control and adverse events.

The agency indicated that it would allow clinicians to use telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health. During the pandemic, individuals can use commonly available interactive apps with audio and video capabilities to visit with their clinician. 


CMS in recent weeks has announced a series of new flexibilities that allow hospices to perform more functions via telehealth than were previously allowed. The recent $2.2 trillion CARES Act stimulus package, designed to help the economy and essential industries weather the impact of the pandemic, also contains provisions related to hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters. These waivers are temporary for the duration of the COVID-19 national emergency.

However, the agency to date has not allowed hospices to bill for these telehealth services, or to include these virtual visits on their cost reports. The lack of cost reporting could have a larger impact, as CMS uses the reports to calculate hospice per diem payment rates. While internal discussions with stakeholders are ongoing, to date this has not changed.

“Hospices can deliver services to a Medicare patient receiving routine home care through telecommunications technology (e.g., remote patient monitoring; telephone calls (audio only and TTY); and 2-way audio-video technology), if it is feasible and appropriate to do so,” a CMS spokesperson told Hospice News in an email. “Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the hospice physician/hospice nurse practitioner and the patient). The waivers and rule changes announced April 29 did not address hospice further.”