---
kind: "section"
citation: "42 C.F.R. § 418.74"
title: "42"
number: "418.74"
heading: "Waiver of requirement—Physical therapy, occupational therapy, speech-language pathology, and dietary counseling."
url: "https://uscodex.org/cfr/42/418.74"
---

# §418.74. Waiver of requirement—Physical therapy, occupational therapy, speech-language pathology, and dietary counseling.

- (a) A hospice located in a non-urbanized area may submit a written request for a waiver of the requirement for providing physical therapy, occupational therapy, speech-language pathology, and dietary counseling services. The hospice may seek a waiver of the requirement that it make physical therapy, occupational therapy, speech-language pathology, and dietary counseling services (as needed) available on a 24-hour basis. The hospice may also seek a waiver of the requirement that it provide dietary counseling directly. The hospice must provide evidence that it has made a good faith effort to meet the requirements for these services before it seeks a waiver. CMS may approve a waiver application on the basis of the following criteria:
  - (1) **The hospice is located in a non-urbanized area as determined by the Bureau of the Census.**
  - (2) The hospice provides evidence that it had made a good faith effort to make available physical therapy, occupational therapy, speech-language pathology, and dietary counseling services on a 24-hour basis and/or to hire a dietary counselor to furnish services directly. This evidence must include the following:
    - (i) **Copies of advertisements in local newspapers that demonstrate recruitment efforts.**
    - (ii) Physical therapy, occupational therapy, speech-language pathology, and dietary counselor job descriptions.
    - (iii) **Evidence that salary and benefits are competitive for the area.**
    - (iv) Evidence of any other recruiting activities (for example, recruiting efforts at health fairs and contact discussions with physical therapy, occupational therapy, speech-language pathology, and dietary counseling service providers in the area).
- (b) **Any waiver request is deemed to be granted unless it is denied within 60 days after it is received.**
- (c) An initial waiver will remain effective for 1 year at a time from the date of the request.
- (d) If a hospice wishes to receive a 1-year extension, it must submit a request to CMS before the expiration of the waiver period and certify that conditions under which it originally requested the waiver have not changed since the initial waiver was granted.

## Notes

### Source

Source: 73 FR 32204, June 5, 2008, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 48 FR 56026, Dec. 16, 1983, unless otherwise noted.