| (a) CMS may approve a waiver for nursing services or
occupational, physical, and speech therapies provided by a hospice
which is located in a non-urbanized area. The location of a hospice
that operates in several areas is considered to be the location of
its central office. The hospice must provide evidence that it was
operational on or before January 1, 1983, and that it made a good
faith effort to hire a sufficient number of nurses or therapists to
provide services directly. CMS bases its decision on whether to approve
a waiver application on the following:
(1) the current Bureau of the Census designations for
determining non-urbanized areas;
(2) evidence that a hospice was operational on or before
January 1, 1983, including:
(A) proof that the organization was established to
provide hospice services on or before January 1, 1983;
(B) evidence that hospice-type services were furnished
to patients on or before January 1, 1983; and
(C) evidence that the hospice care was a discrete activity
rather than an aspect of another type of provider's patient care program
on or before January 1, 1983; and
(3) evidence that a hospice made a good faith effort
to hire nurses or therapists, including:
(A) copies of advertisements in local newspapers that
demonstrate recruitment efforts;
(B) job descriptions for nurse employees or therapists;
(C) evidence that salary and benefits are competitive
for the area; and
(D) evidence of any other recruiting activities, such
as recruiting efforts at health fairs and contacts with nurses or
therapists at other providers in the area.
(b) A waiver request for occupational, physical, and
speech therapies must be submitted in writing to HHSC.
(c) HHSC will recommend in writing, approval or disapproval
of the requested waiver for occupational, physical, and speech therapies
to CMS within 30 days of receiving the request.
(d) CMS receives requests for waivers of nursing services
without the involvement of HHSC.
(e) Any waiver request is deemed to be granted unless
it is denied within 60 days after it is received.
(f) Waivers will remain effective for one year at a
time.
(g) CMS may approve a maximum of two one-year extensions
for each initial waiver. If a hospice wishes to receive a one-year
extension, the hospice must submit a certification to CMS, prior to
the expiration of the waiver period, that the employment market for
nurses and therapists has not changed significantly since the time
the initial waiver was granted.
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