CMS to Require COVID Tests for Hospice Staff Visiting Nursing Homes

Hospice staff visiting patients in nursing homes must undergo testing for COVID-19 at a frequency determined by the prevalence of the virus in their location. This is required under an interim final rule from the U.S. Centers for Medicare & Medicaid Services (CMS).

While the final rule pertains specifically to nursing homes, it applies to any individuals employed by the facility, any individuals that have arrangements to provide services for the facility and any individuals volunteering at the facility. The agency cited hospice providers as an example of those who have arrangements to provide services.

“As the health care community establishes and implements recommended infection prevention and control practices, regulatory agencies operating under appropriate waiver authority granted by the public health emergency for COVID-19 are also working to revise and implement regulations that support these health care community infection prevention and treatment practices,” CMS indicated in the rule. “Based on the current and projected increases in the COVID-19 incidence rates in the US, observed fatalities in the older adult population, and the impact on health workers who are at increased risk due to treating special populations, it is CMS’ belief that certain regulations should be reviewed and revised as appropriate to offer additional flexibilities in furnishing and providing services to combat the [public health emergency] for COVID-19.”


Nearly 18% of hospice care in the United States occurred in nursing homes during 2018, according to the National Hospice & Palliative Care Organization, exceeded only by private residences and assisted living facilities. 

Senior citizens are particularly vulnerable to COVID-19, according to the U.S. Centers for Disease Control & Prevention (CDC). Consequently, nursing homes have been struck particularly hard by the pandemic that has engulfed the country since at least March.

Nursing homes nationwide have seen more than 198,000 novel coronavirus infections and nearly 120,000 suspected cases, CDC reported. These have resulted in close to 20,000 deaths since the onset of the pandemic.


Many hospices experienced difficulty accessing their patients who reside in nursing homes due to restrictions from those facilities as to who may enter. This has persisted despite CMS indicating that hospice workers should be considered essential and allowed in. In the early days of the pandemic, hospice leaders cited those restrictions as a top concern for 2020, with many saying that removal of those restrictions were likely to be the COVID-related issue that could most impact their businesses and their patients and staff.

CMS encouraged hospices to communicate with the nursing homes they partner with to stay informed of their testing procedures and frequency.

“We expect that only those individuals that are physically working on-site at the facility be required to be tested for COVID-19,” CMS indicated.”The facility may have staff, including individuals providing services under arrangement and volunteers, who provide services for the facility from an off-site location that is not physically located within the facility, and such staff would not be required to be tested for COVID-19.”