Preparing Hospice for the End of the COVID-19 PHE

  • Stay tuned to NAHC Report for details on an upcoming webinar regarding preparing for the end of the PHE.

The COVID-19 Public Health Emergency (PHE) which began in early 2020 will come to an end on May 11, 2023.  Throughout the PHE various waivers, regulations, enforcement discretion, and sub-regulatory guidance were utilized to ensure access to care and give health care providers the flexibilities needed to respond to the PHE.  Some of these flexibilities became permanent over the years and some have been extended and will end after May 11.  In August 2022 CMS created a Roadmap for the end of the PHE to help guide providers towards returning to previous health and safety standards and billing practices.

As part of its Roadmap CMS issued provider-specific guidance that details plans for the phase out of various waivers and flexibilities. Below are links to two documents that address home health and hospice waivers and flexibilities:

The fact sheets were last updated on February 1, 2023 and it is important to note that CMS will be making additional updates.  NAHC contacted CMS shortly after the announcement of the end of the PHE to find out when CMS would update the fact sheets with the latest telehealth flexibilities, in particular. CMS indicated that it is working across the agency to have a consistent plan of action in making any of the necessary changes to reflect the provisions in the most recent Consolidated Appropriations Act (CAA) and other applicable changes.  (See previous NAHC Report coverage of the CAA here.)

The updated COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers document lists most of the healthcare waivers and flexibilities in provider-specific sections.  However, it does not include a CMS statement on how each waiver is being handled.  The fact sheets include this information. Providers should be aware that unless a PHE waiver or flexibility has been extended or otherwise became permanent, CMS expects providers to be in full compliance with the requirements beginning May 12, 2023.

NAHC still has questions/concerns about expectations around provider responsibilities for some of the flexibilities.  We are awaiting a response from CMS and will update providers when we have more information.  We are also reviewing the waivers and flexibilities in light of the impending end date of May 11, 2023 and may have more questions we submit to CMS.  Until then, we are including below those waivers/flexibilities for which NAHC has had questions/concerns.  The questions/concerns are identified in bold next to the waiver/flexibility to which they apply.


Annual Training: CMS is modifying the requirement at 42 CFR §418.100(g)(3), which requires hospices to annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs where required. Pursuant to section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This does not alter the minimum personnel requirements at 42 CFR §418.114.

Selected hospice staff must complete training and have their competency evaluated in accordance with unwaived provisions of 42 CFR Part 418. CMS will end this waiver at the conclusion of the PHE. Clarification is needed regarding whether postponed assessments must be completed within the first full quarter after the declaration of the PHE concludes or just the current year’s postponed assessment.

Stay tuned to NAHC Report for details on an upcoming webinar regarding preparing for the end of the PHE.