On October 3, 2014, CMS issued S&C: 12-43-Hospice entitled "Impact of Nursing Shortage on Hospice Care".
In the memorandum, CMS explains that the Bureau of Labor Statistics continues to forecast a shortage of nurses through 2022. As a result, CMS is extending the time period in which Hospices can qualify for an “extraordinary circumstance” exemption when they believe that the nursing shortage has affected their ability to directly hire sufficient numbers of nurses.
The hospice conditions of participation require providers to ensure that substantially all the core services are routinely provided directly by hospice employees. Nursing is a core hospice service. CMS acknowledges that some hospices may find that the current shortage of nurses is having a significant impact on access to hospice services and that hospices have had to deny services to eligible patients because they do not have adequate staff to provide nursing services. As a result, CMS is providing more time for hospices to use the exemption.
According to the memorandum, the exemption policy will continue through September 30, 2016. The memorandum also describes how to qualify for an exemption.
A copy of the S&C Memo can be found here - http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-01.pdf