This memorandum extends the period of time for hospice agencies to qualify for an extraordinary circumstance exemption when
they believe that the nursing shortage has affected their ability to directly hire sufficient numbers of nurses. This policy
exemption was first outlined in S&C-02-44 and again in S&C-05-02 and 06-28. The effective date of this policy has been extended
from September 30, 2008 to September 30, 2010.