[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR418.83]



[Page 921]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 418_HOSPICE CARE--Table of Contents

 

          Subpart D_Conditions of Participation: Core Services

 

Sec. 418.83  Nursing services--Waiver of requirement that substantially 

all nursing services be routinely provided directly by a hospice.



    (a) CMS may approve a waiver of the requirement in Sec. 418.80 for 

nursing services provided by a hospice which is located in a non-

urbanized area. The location of a hospice that operates in several areas 

is considered to be the location of its central office. The hospice must 

provide evidence that it was operational on or before January 1, 1983, 

and that it made a good faith effort to hire a sufficient number of 

nurses to provide services directly. CMS bases its decision as to 

whether to approve a waiver application on the following:

    (1) The current Bureau of the Census designations for determining 

non-urbanized areas.

    (2) Evidence that a hospice was operational on or before January 1, 

1983 including:

    (i) Proof that the organization was established to provide hospice 

services on or before January 1, 1983;

    (ii) Evidence that hospice-type services were furnished to patients 

on or before January 1, 1983; and

    (iii) Evidence that the hospice care was a discrete activity rather 

than an aspect of another type of provider's patient care program on or 

before January 1, 1983.

    (3) Evidence that a hospice made a good faith effort to hire nurses, 

including:

    (i) Copies of advertisements in local newspapers that demonstrate 

recruitment efforts;

    (ii) Job descriptions for nurse employees;

    (iii) Evidence that salary and benefits are competitive for the 

area; and

    (iv) Evidence of any other recruiting activities (e.g., recruiting 

efforts at health fairs and contacts with nurses at other providers in 

the area);

    (b) Any waiver request is deemed to be granted unless it is denied 

within 60 days after it is received.

    (c) Waivers will remain effective for one year at a time.

    (d) CMS may approve a maximum of two one-year extensions for each 

initial waiver. If a hospice wishes to receive a one-year extension, the 

hospice must submit a certification to CMS, prior to the expiration of 

the waiver period, that the employment market for nurses has not changed 

significantly since the time the initial waiver was granted.



[52 FR 7416, Mar. 11, 1987]