Extension of the Designation of the Current Nursing Shortage as an “Extraordinary Circumstance” per 42 CFR 418.64 Core Services
• Extraordinary Circumstances as Related to Hospice Staffing Requirements: The Centers for Medicare & Medicaid Services (CMS)
has extended its designation of the national nursing shortage as an extraordinary circumstance for an additional two (2) years.
This designation enables those hospice agencies, which are unable to provide a sufficient number of nursing staff directly
to meet the needs of its patients due to the national shortage, to utilize contracted staff in addition to their full time
• Compliance Determination: CMS is eliminating the previous requirement that the hospice agency must notify CMS of its use
of contacted staff during extraordinary circumstances and submit justification for such use to its State Survey Agency. This
notification/justification is not required by 42 CFR 418.64. Compliance with the regulation for use of contracted staff will
be reviewed as a part of the routine survey process.
• Hospice Responsibility: When contract services are utilized, the hospice agency maintains all professional, financial and
administrative responsibility for the services.
• This policy memorandum serves as an extension and supersedes previously issued SC17-01-Hospice.