(a) A hospice must routinely provide substantially all core services directly by hospice employees in a manner consistent with accepted standards of practice. A hospice must provide the following core services:(1) physician services;(2) nursing services;(3) medical social services; and(4) counseling services.(b) A hospice may contract for physician services as specified in §558.831 of this division (relating to Hospice Physician Services).(c) A hospice may use contracted staff if necessary to supplement hospice employees to meet the needs of clients under extraordinary or other non-routine circumstances. A Medicare-certified hospice may also enter into a written contract with another Medicare-certified hospice to provide core services if necessary to supplement hospice employees to meet the needs of a client. The contracting hospice must maintain professional management responsibility for the services provided in accordance with §558.854 of this subchapter (relating to Hospice Professional Management Responsibility). Circumstances under which the hospice may enter into a written contract for the provision of core services include:(1) unanticipated periods of high client loads;(2) staffing shortages due to illness or other short-term temporary staffing situations that could interrupt client care; and(3) temporary travel of a client outside of the hospice's service area.