Waiver for Core Services

If the hospice is located in a nonurbanized area, it may apply for a waiver of the core nursing, physical therapy, occupational therapy, speech language pathology, and dietary counseling requirements if it can demonstrate that it made a good faith or diligent effort to hire these specialties. Determinations as to urbanized and nonurbanized areas are based on the current Census Bureau. The location of a hospice that operates in several areas is considered to be the location of its central office.
To qualify for the nursing services waiver, the hospice must have been operational on or before January 1, 1983.
Determinations as to whether it was operational on or before January 1, 1983, are based on:

* Proof that it was established to provide hospice services prior to 1983 (e.g., newspaper advertisements, dated correspondence on hospice letterhead, dated invoices, articles of incorporation, governing body minutes);

*Evidence that it furnished hospice-type services to patients on or before that time (e.g., dated copies of medical records, dated nursing notes, dated pharmaceutical orders); and

* Evidence that hospice care was a discrete activity rather than an aspect of a provider’s patient care program prior to January 1, 1983.
Determinations of good faith or diligent efforts to hire appropriate personnel for all waiver services are based on the following evidence:
* Recruitment efforts through advertisements in local newspapers;

*Job descriptions for nurses, physical therapists, occupational therapists, speech-language pathologist, and dietary counselors;

*Evidence that salary and benefits are competitive for the area; and
* Any other recruiting activities (e.g., recruiting efforts at health fair and contacts with appropriate personnel at other providers in the area).

A waiver remains in effect for a 1-year period. A waiver may be extended for two additional 1-year periods. Prior to each additional year, the hospice must request the extension and certify that the employment market for appropriate personnel has not changed significantly since the initial waiver was granted if this is the case. No additional evidence is required with this certification.
Waiver requests and any extensions with supporting documentation must be sent to the regional office for review. Regional offices have the authority to review, and approve, or deny the waiver application.