CMS Pub. 100-02, ch. 9, § 40.4.2

Hospices are prohibited from contracting with other hospices and non-hospice agencies

on a routine basis for the provision of the core services of nursing, medical social services

and counseling to hospice patients. A hospice may, however, enter into arrangements

with another hospice program or other entity for the provision of these core services in

extraordinary, exigent, or other non-routine circumstances. An extraordinary

circumstance generally would be a short-term temporary event that was unanticipated.

Examples of such circumstances might include unanticipated periods of high patient

loads, caused by an unexpectedly large number of patients requiring continuous care

simultaneously, temporary staffing shortages due to illness, receiving patients evacuated

from a disaster such as a hurricane or a wildfire, or temporary travel of a patient outside

the hospice’s service area. The hospice that contracts for services must maintain

professional management responsibility for all services provided under arrangement or

contract at all times and in all settings. Regulations at 42 CFR 418.100(e) discuss the

professional management responsibilities of the hospice for services provided under

arrangement.

Hospices must maintain evidence of the extraordinary circumstances that required them

to contract for the core services and comply with the following:

(a) The hospice must ensure that contracted staff is providing care that is consistent

with the hospice philosophy and the patient's plan of care and is actively

participating in the coordination of all aspects of the patient’s hospice care.

Hospices may not routinely contract for a specific level of care (e.g., continuous care) or

for specific hours of care (e.g., evenings and week-ends).