Hospice Contracting For On-Call Services And Continuous Care

Hospice providers should take note that Medicare regulations prohibit hospices from contracting for nursing services unless one of the following exceptions is met:

Extraordinary Circumstances

  • Nursing Services Waiver – found in the Hospice Conditions of Participation at 418.66
  • Waiver of Certain Staffing Requirements – found in the State Operations Manual at 2080C.1
  • Contracting for Highly Specialized Services – found in the State Operations Manual at 2080C.2

The prohibition on contracting for nursing services is applicable to on-call services and continuous care. HAA has heard numerous reports of companies offering to contract with Medicare-certified hospices for on-call services or telephone triage. These contracts violate the CMS conditions of participation if the on-call service is staffed by nurses not employed by the hospice and those nurses are triaging calls, providing advice to the patient, or in any other way providing hospice nursing services. It is acceptable for hospices to contract with an on-call answering service even if that service is manned by nurses provided the nurses do not deliver any nursing services and are only answering calls and transferring them to hospice – employed staff, as appropriate.

For quite some time, CMS has indicated that contracted staff should not routinely provide continuous care. Having a pool of contracted RNs, LPNs, and Aides available for continuous care is in violation of the core services requirement if the pool includes contracted staff and does not meet one of the exceptions stated above. CMS has specifically stated in the Medicare Benefit Policy Manual that continuous care is not a highly specialized service. It is acceptable to have a pool of continuous care staff that are employed on a PRN or “as needed” basis only.


From the NAHC Report Article