This All Facilities Letter (AFL) is being sent to notify you of legislative changes to the Health and Safety Code and provide information regarding the new option for a licensed and certified hospice provider to operate a licensed hospice facility.

Effective January 1, 2013, SB 135 established a new hospice facility licensure category and permits a licensed and certified hospice services provider to provide inpatient hospice care through the operation of a hospice facility.

A hospice facility is defined as a "health facility licensed pursuant to this chapter [Chapter 2], with a capacity of no more than 24 beds that provides hospice services. Hospice services include, but are not limited to, routine care, continuous care, inpatient respite care, and inpatient hospice care as defined in subdivision (d) of Section 1339.40, and is operated by a provider of hospice services that is licensed pursuant to Section 1751 and certified as a hospice pursuant to Part 418 of Title 42 of the Code of Federal Regulations (CFR)" (HSC 1250 (n)).

Currently, state law provides for the licensure of agencies providing hospice services which could be provided in the patient’s home or primary place of residence, or as a service of a Congregate Living Health Facility (CLHF), or to residents of a facility via contract, based on the medical needs of the patient.

Under the new law, hospice providers that intend to provide inpatient hospice care in their own facility must apply for a hospice facility license. Hospice providers will have the option to operate a hospice facility either as a freestanding hospice facility or as a facility that is within the physical plant of another licensed health facility. For additional information regarding the requirements for a hospice facility that is located within the physical plant of another licensed health facility, please review HSC Section 1339.43(e).

SB 135 requires hospice facilities to comply with the federal Centers for Medicare and Medicaid Services (CMS) hospice regulations, and meet the building and fire protection standards as specified in Section 418 of Title 42 of the CFR until the Office of Statewide Health Planning and Development has developed and adopted new regulations for building and fire protection, and CDPH has developed and adopted regulations for hospice facilities. CFR Section 418.110 specifies the standards applicable to hospices that provide inpatient care directly. The inpatient care standards can be found at Title 42 CFR section 418.110. 

In addition, SB 135 prohibits any unlicensed private or public organization from:

1. Representing itself to be a hospice facility by its name or advertisement, soliciting, or any other presentments to the public, or in the context of services within the scope of the provisions of this bill imply that it is licensed to provide those services or to make any reference to employee bonding in relation to those services;
2. Using the words "hospice facility," "hospice home," "hospice-facility," or any combination of those terms, within its name; or,
3. Using words to imply that it is licensed as a hospice facility to provide those services.

Consistent with existing requirements for hospice providers, a hospice facility licensee is also required to obtain criminal background checks for its employees, volunteers, and contractors in accordance with the federal Medicare Conditions of Participation CFR Section 418.114 (d). The hospice facility licensee shall pay the costs of obtaining a criminal background check.

The hospice facility must protect and promote the rights of hospice patients. In addition to the patients’ rights in Section 418.52 of Title 42 of the Code of Federal Regulations hospice facility licensees must provide each patient with the following:

1. Information at admission to a hospice facility regarding their rights as a patient. a. Effective January 1, 2013, Sections 483.10, 483.12, 483.13, and 483.15 of Title 42 of the Code of Federal Regulations in effect on July 1, 2006, shall apply to each hospice facility, regardless of a resident’s payment source or the Medi-Cal or Medicare certification status of the hospice facility in which the resident resides. A hospice facility is not obligated to comply with the provisions of subdivision (f) of Section 483.15 of Title 42 of the Code of Federal Regulations.
2. Full information regarding his or her health status and options for end-of-life care.
3. Care that reflects individual preferences regarding end-of-life care, including the right to refuse any treatment or procedure.
4. Treatment with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and care of personal needs.
5. Right to visitors of the patient’s choosing, at any time the patient chooses, and privacy for those visits.

The Licensing & Certification fees for hospice facilities in the first year (FY13-14) will be the same fees as CLHFs. Thereafter, the licensure fee for hospice facilities shall be established based on the costs associated with performing licensing activities for the specific facility category pursuant to HSC 1266. The licensure fee is based on the number of beds on the license. Fees are updated annually on the CDPH website and can be accessed on the Health Care Facility Licensing Fees webpage.  

Providers seeking hospice facility licensure should use the Licensing and Certification form HS 200 and select the "other" facility type option and write in "hospice facility". Required hospice facility licensing and certification forms including the application form and a helpful checklist can be found on the Hospice Facility Initial Application Packet webpage. 

The information in this AFL is a brief summary of SB 135. Facilities are responsible for following all applicable laws. CDPH’s failure to expressly notify facilities of legislative changes and/or statutory and regulatory requirements does not relieve facilities of their responsibility for following all laws and for being aware of all legislative changes. Facilities should refer to the full text of Health & Safety Code Sections 1339.40-1339.44 to ensure compliance.

Please see the Frequently Asked Questions, which will hopefully address most of your questions related to hospice facility licensure. If you have any additional questions, please contact your respective L&C District Office. 

Sincerely,

Original signed by Pamela Dickfoss for

Debby Rogers, RN, MS, FAEN
Deputy Director