Nursing Shortage as an “Extraordinary Circumstance” per 42 CFR 418.64

• Extraordinary Circumstances as Related to Hospice Staffing Requirements: A hospice may use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances. The regulation allows the hospice to utilize these services temporarily without a waiver or exemption from the State Survey Agency (SA) or the CMS Location. • Compliance Determination: CMS is updating previous guidance that the hospice agency must notify the CMS of its use of contracted staff during extraordinary circumstances and submit justification for such use to its SA or CMS Location. This notification/justification is not required by 42 CFR 418.64. Compliance with the regulation for use of contracted staff is 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 supersedes previously issued SC17-01-Hospice.