CMS SOM App. M, Tag L606

A hospice located in a non-urbanized area may submit a written request

for a waiver of the requirement for providing physical therapy, occupational

therapy, speech-language pathology, and dietary counseling services. The hospice

may seek a waiver of the requirement that it make physical therapy, occupational

therapy, speech-language pathology, and dietary counseling services (as needed)

available on a 24-hour basis. The hospice may also seek a waiver of the requirement

that it provide dietary counseling directly. The hospice must provide evidence that

it has made a good faith effort to meet the requirements for these services before it

seeks a waiver. CMS may approve a waiver application on the basis of the following

criteria:

1) The hospice is located in a non-urbanized area as determined by the Bureau

of the Census.

2) The hospice provides evidence that it had made a good faith effort to make

available physical therapy, occupational therapy, speech-language pathology,

and dietary counseling services on a 24-hour basis and/or to hire a dietary

counselor to furnish services directly. This evidence must include the

following:

(i) Copies of advertisements in local newspapers that demonstrate

recruitment efforts.

(ii) Physical therapy, occupational therapy, speech-language

pathology, and dietary counselor job descriptions.

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

(iv) Evidence of any other recruiting activities (for example, recruiting

efforts at health fairs and contact discussions with physical

therapy, occupational therapy, speech-language pathology, and

dietary counseling service providers in the area).

(a) Any waiver request is deemed to be granted unless it is denied within 60 days

after it is received.

(b) An initial waiver will remain effective for 1 year at a time from the date of the

request.

(c) If a hospice wishes to receive a 1-year extension, it must submit a request to

CMS before the expiration of the waiver period and certify that conditions

under which it originally requested the waiver have not changed since the initial

waiver was granted.

Interpretive Guidelines §418.74

Eligibility for this waiver, as with the nursing waiver, is based on the primary location of

the hospice. If the hospice operates in multiple locations, the primary location is

considered to be location of the central office. This office must be located in a non-urbanized area as determined by the Bureau of Census.

This waiver does not waive the hospice’s responsibility to provide PT, OT, SLP, and

dietary counseling; but rather waives the requirement to provide them on a 24-hour basis.

There are no limit restrictions to the number of extensions a hospice may request to the

original waiver request.