Section 418.114 - Condition of participation: Personnel qualifications(a)General qualification requirements. Except as specified in paragraph (c) of this section, all professionals who furnish services directly, under an individual contract, or under arrangements with a hospice, must be legally authorized (licensed, certified or registered) in accordance with applicable Federal, State and local laws, and must act only within the scope of his or her State license, or State certification, or registration. All personnel qualifications must be kept current at all times.(b)Personnel qualifications for certain disciplines. The following qualifications must be met: (1)Physician. Physicians must meet the qualifications and conditions as defined in section 1861(r) of the Act and implemented at § 410.20 of this chapter.(2)Hospice aide. Hospice aides must meet the qualifications required by section 1891(a)(3) of the Act and implemented at § 418.76 .(3)Social worker. A person who-(i)(A) Has a Master of Social Work (MSW) degree from a school of social work accredited by the Council on Social Work Education; or(B) Has a baccalaureate degree in social work from an institution accredited by the Council on Social Work Education; or a baccalaureate degree in psychology, sociology, or other field related to social work and is supervised by an MSW as described in paragraph (b)(3)(i)(A) of this section; and(ii) Has 1 year of social work experience in a healthcare setting; or(iii) Has a baccalaureate degree from a school of social work accredited by the Council on Social Work Education, is employed by the hospice before December 2, 2008, and is not required to be supervised by an MSW.(4)Speech language pathologist. A person who meets either of the following requirements:(i) The education and experience requirements for a Certificate of Clinical Competence in speech-language pathology granted by the American Speech-Language-Hearing Association.(ii) The educational requirements for certification and is in the process of accumulating the supervised experience required for certification.(5)Occupational therapist. A person who-(i)(A) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing, unless licensure does not apply;(B) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA), or successor organizations of ACOTE; and(C) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).(ii) On or before December 31, 2009- (A) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing; or(B) When licensure or other regulation does not apply-(1) Graduated after successful completion of an occupational therapist education program accredited by the accreditation Council for Occupational therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or successor organizations of ACOTE; and(2) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc., (NBCOT).(iii) On or before January 1, 2008-(A) Graduated after successful completion of an occupational therapy program accredited jointly by the committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association; or(B) Is eligible for the National Registration Examination of the American Occupational Therapy Association or the National Board for Certification in Occupational Therapy.(iv) On or before December 31, 1977-(A) Had 2 years of appropriate experience as an occupational therapist; and(B) Had achieved a satisfactory grade on an occupational therapist proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service.(v) If educated outside the United States- (A) Must meet both of the following: (1) Graduated after successful completion of an occupational therapist education program accredited as substantially equivalent to occupational therapist assistant entry level education in the United States by one of the following:(i) The Accreditation Council for Occupational Therapy Education (ACOTE).(ii) Successor organizations of ACOTE.(iii) The World Federation of Occupational Therapists.(iv) A credentialing body approved by the American Occupational Therapy Association.(v) Successfully completed the entry level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).(2) On or before December 31, 2009, is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing.(6)Occupational therapy assistant. A person who(i) Meets all of the following:(A) Is licensed or otherwise regulated, if applicable, as an occupational therapy assistant by the State in which practicing, unless licensure does apply.(B) Graduated after successful completion of an occupational therapy assistant education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA) or its successor organizations.(C) Is eligible to take or successfully completed the entry-level certification examination for occupational therapy assistants developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).(ii) On or before December 31, 2009-(A) Is licensed or otherwise regulated as an occupational therapy assistant, if applicable, by the State in which practicing; or any qualifications defined by the State in which practicing, unless licensure does not apply; or(B) Must meet both of the following: (1) Completed certification requirements to practice as an occupational therapy assistant established by a credentialing organization approved by the American Occupational Therapy Association.(2) After January 1, 2010, meets the requirements in paragraph (b)(6)(i) of this section.(iii) After December 31, 1977 and on or before December 31, 2007- (A) Completed certification requirements to practice as an occupational therapy assistant established by a credentialing organization approved by the American Occupational Therapy Association; or(B) Completed the requirements to practice as an occupational therapy assistant applicable in the State in which practicing.(iv) On or before December 31, 1977-(A) Had 2 years of appropriate experience as an occupational therapy assistant; and(B) Had achieved a satisfactory grade on an occupational therapy assistant proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service.(v) If educated outside the United States, on or after January 1, 2008-(A) Graduated after successful completion of an occupational therapy assistant education program that is accredited as substantially equivalent to occupational therapist assistant entry level education in the United States by- (1) The Accreditation Council for Occupational Therapy Education (ACOTE).(2) Its successor organizations.(3) The World Federation of Occupational Therapists.(4) By a credentialing body approved by the American Occupational Therapy Association; and(5) Successfully completed the entry level certification examination for occupational therapy assistants developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT).(7)Physical therapist. A person who is licensed, if applicable, by the State in which practicing, unless licensure does not apply and meets one of the following requirements: (i) Graduated after successful completion of a physical therapist education program approved by one of the following: (A) The Commission on Accreditation in Physical Therapy Education (CAPTE).(B) Successor organizations of CAPTE.(C) An education program outside the United States determined to be substantially equivalent to physical therapist entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or an organization identified in 8 CFR 212.15(e) as it relates to physical therapists.(D) Passed an examination for physical therapists approved by the State in which physical therapy services are provided.(ii) On or before December 31, 2009- (A) Graduated after successful completion of a physical therapy curriculum approved by the Commission on Accreditation in Physical Therapy Education (CAPTE); or(B) Meets both of the following: (1) Graduated after successful completion of an education program determined to be substantially equivalent to physical therapist entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or identified in 8 CFR 212.15(e) as it relates to physical therapists.(2) Passed an examination for physical therapists approved by the State in which physical therapy services are provided.(iii) Before January 1, 2008- (A) Graduated from a physical therapy curriculum approved by one of the following: (1) The American Physical Therapy Association.(2) The Committee on Allied Health Education and Accreditation of the American Medical Association.(3) The Council on Medical Education of the American Medical Association and the American Physical Therapy Association.(iv) On or before December 31, 1977 was licensed or qualified as a physical therapist and meets both of the following: (A) Has 2 years of appropriate experience as a physical therapist.(B) Has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service.(v) Before January 1, 1966- (A) Was admitted to membership by the American Physical Therapy Association;(B) Was admitted to registration by the American Registry of Physical Therapists; and(C) Graduated from a physical therapy curriculum in a 4-year college or university approved by a State department of education.(vi) Before January 1, 1966 was licensed or registered, and before January 1, 1970, had 15 years of fulltime experience in the treatment of illness or injury through the practice of physical therapy in which services were rendered under the order and direction of attending and referring doctors of medicine or osteopathy.(vii) If trained outside the United States before January 1, 2008, meets the following requirements: (A) Was graduated since 1928 from a physical therapy curriculum approved in the country in which the curriculum was located and in which there is a member organization of the World Confederation for Physical Therapy.(B) Meets the requirements for membership in a member organization of the World Confederation for Physical Therapy.(8)Physical therapist assistant. A person who is licensed, registered or certified as a physical therapist assistant, if applicable, by the State in which practicing, unless licensure does not apply and meets one of the following requirements: (i) Graduated from a physical therapist assistant curriculum approved by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association; or if educated outside the United States or trained in the United States military, graduated from an education program determined to be substantially equivalent to physical therapist assistant entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or identified at 8 CFR 212.15(e) ; and(ii) Passed a national examination for physical therapist assistants.(A) On or before December 31, 2009, meets one of the following: (1) Is licensed, or otherwise regulated in the State in which practicing.(2) In States where licensure or other regulations do not apply, graduated before December 31, 2009, from a 2-year college-level program approved by the American Physical Therapy Association and after January 1, 2010, meets the requirements of paragraph (b)(8) of this section.(3) Before January 1, 2008, where licensure or other regulation does not apply, graduated from a 2-year college level program approved by the American Physical Therapy Association.(4) On or before December 31, 1977, was licensed or qualified as a physical therapist assistant and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service.(9) Marriage and family therapist as defined at § 410.53 .(10) Mental health counselor as defined at § 410.54 .(c)Personnel qualifications when no State licensing, certification or registration requirements exist. If no State licensing laws, certification or registration requirements exist for the profession, the following requirements must be met: (1)Registered nurse. A graduate of a school of professional nursing.(2)Licensed practical nurse. A person who has completed a practical nursing program.(d)Standard: Criminal background checks.(1) The hospice must obtain a criminal background check on all hospice employees who have direct patient contact or access to patient records. Hospice contracts must require that all contracted entities obtain criminal background checks on contracted employees who have direct patient contact or access to patient records.(2) Criminal background checks must be obtained in accordance with State requirements. In the absence of State requirements, criminal background checks must be obtained within three months of the date of employment for all states that the individual has lived or worked in the past 3 years. 73 FR 32204 , June 5, 2008, as amended at 88 FR 79539 , Nov. 16, 2023 88 FR 79539 , 1/1/2024; 89 FR 64272 , 10/1/2024