Article 10.6. Hospice Licensing of California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 10.6.
For the purposes of this article, the following
(a) "Bereavement services" has the same meaning as defined in
subdivision (a) of Section 1746.
(b) "Hospice care" means a specialized form of interdisciplinary
health care that is designed to provide palliative care, alleviate
the physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the following criteria:
(1) Considers the patient and the patient's family, in addition to
the patient, as the unit of care.
(2) Utilizes an interdisciplinary team to assess the physical,
medical, psychological, social, and spiritual needs of the patient
and the patient's family.
(3) Requires the interdisciplinary team to develop an overall plan
of care and to provide coordinated care that emphasizes supportive
services, including, but not limited to, home care, pain control, and
limited inpatient services. Limited inpatient services are intended
to ensure both continuity of care and appropriateness of services for
those patients who cannot be managed at home because of acute
complications or the temporary absence of a capable primary
(4) Provides for the palliative medical treatment of pain and
other symptoms associated with a terminal disease, but does not
provide for efforts to cure the disease.
(5) Provides for bereavement services following death to assist
the family in coping with social and emotional needs associated with
the death of the patient.
(6) Actively utilizes volunteers in the delivery of hospice
(7) To the extent appropriate, based on the medical needs of the
patient, provides services in the patient's home or primary place of
(c) "Hospice facility" means a health facility as defined in
subdivision (n) of Section 1250.
(d) "Inpatient hospice care" means hospice care that is provided
to patients in a hospice facility, including routine, continuous and
inpatient care directly as specified in Section 418.110 of Title 42
of the Code of Federal Regulations, and may include short-term
inpatient respite care as specified in Section 418.108 of Title 42 of
the Code of Federal Regulations.
(e) "Interdisciplinary team" has the same meaning as defined in
subdivision (g) of Section 1746.
(f) "Medical direction" has the same meaning as defined in
subdivision (h) of Section 1746.
(g) "Palliative care" has the same meaning as defined in
subdivision (j) of Section 1746.
(h) "Plan of care" has the same meaning as defined in subdivision
(l) of Section 1746.
(i) "Skilled nursing services" has the same meaning as defined in
subdivision (n) of Section 1746.
(j) "Social services/counseling services" has the same meaning as
defined in subdivision (o) of Section 1746.
(k) "Terminal disease" or "terminal illness" has the same meaning
as defined in subdivision (p) of Section 1746.
(l) "Volunteer services" has the same meaning as defined in
subdivision (q) of Section 1746.
(a) A person, governmental agency, or political
subdivision of the state shall not be licensed as a hospice facility
under this chapter unless the person or entity is a provider of
hospice services licensed pursuant to Section 1751 and is certified
as a hospice facility under Part 418 of Title 42 of the Code of
(b) A hospice provider that intends to provide inpatient hospice
care in the hospice provider's own facility shall submit an
application and fee for licensure as a hospice facility under this
chapter. Notwithstanding the maximum period for a provisional license
under subdivision (b) of Section 1268.5, the department may issue a
provisional license to a hospice facility for a period of up to one
(c) A verified application for a new license completed on forms
furnished by the department shall be submitted to the department upon
the occurrence of either of the following:
(1) Establishment of a hospice facility.
(2) Change of ownership.
(d) The licensee shall submit to the department a verified
application for a corrected license completed on forms furnished by
the department upon the occurrence of any of the following:
(1) Construction of new or replacement hospice facility.
(2) Increase in licensed bed capacity.
(3) Change of name of facility.
(4) Change of licensed category.
(5) Change of location of facility.
(6) Change in bed classification.
(e) (1) A hospice facility that participates in the Medicare and
Medicaid programs may obtain initial certification from a federal
Centers for Medicare and Medicaid Services (CMS) approved
(2) If the CMS-approved accreditation organization conducts
certification inspections, the hospice facility shall transmit to the
department, within 30 days of receipt, a copy of the final
accreditation report of the accreditation organization.
(f) A hospice facility shall be separately licensed, irrespective
of the location of the facility.
(g) (1) The licensee shall notify the department in writing of any
changes in the information provided pursuant to subdivision (d)
within 10 days of these changes. This notice shall include
information and documentation regarding the changes.
(2) Each licensee shall notify the department within 10 days in
writing of any change of the mailing address of the licensee. This
notice shall include the new mailing address of the licensee.
(3) When a change in the principal officer of a corporate
licensee, including the chairman, president, or general manager
occurs, the licensee shall notify the department of this change
within 10 days in writing. This notice shall include the name and
business address of the officer.
(4) Any decrease in licensed bed capacity of the facility shall
require notification by letter to the department and shall result in
the issuance of a corrected license.
(a) No private or public organization, including, but not
limited to, any partnership, corporation, or political subdivision of
the state, or other governmental agency within the state, shall do
any of the following without a license issued pursuant to this
(1) Represent 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 this chapter imply
that it is licensed to provide those services or to make any
reference to employee bonding in relation to those services.
(2) Use the words "hospice facility," "hospice home,"
"hospice-facility," or any combination of those terms, within its
(3) Use words to imply that it is licensed as a hospice facility
to provide those services.
(b) A hospice facility licensee shall obtain criminal background
checks for its employees, volunteers, and contractors in accordance
with federal Medicare conditions of participation (42 C.F.R. Part 418
et seq.) and as may be required in accordance with state law. The
hospice facility licensee shall pay the costs of obtaining a criminal
(a) A hospice facility shall provide a home-like
environment that is comfortable and accommodating to both the patient
and patient's visitors.
(b) Building standards for hospice facilities adopted pursuant to
this chapter relating to fire and panic safety, and other regulations
for hospice facilities adopted pursuant to this chapter, shall apply
uniformly throughout the state. No city, county, city and county,
including a charter city or charter county, or fire protection
district shall adopt or enforce any ordinance or local rule or
regulation relating to fire and panic safety in buildings or
structures subject to this section that is inconsistent with the
rules and regulations for hospice facilities adopted pursuant to this
(c) The hospice facility shall meet the fire protection standards
set forth in the federal Medicare conditions of participation (42
C.F.R. Part 418 et seq.).
(d) A hospice facility may operate as a freestanding health
(1) Until the Office of the State Fire Marshal, in consultation
with the Office of Statewide Health Planning and Development,
develops and adopts building standards for hospice facilities, a
freestanding hospice facility shall meet applicable building
standards and requirements relating to the physical environment of
the facility as specified in Section 418.110 of Title 42 of the Code
of Federal Regulations. The building standards developed shall, at a
minimum, maintain the requirements specified in that section.
(2) A freestanding hospice facility shall be under the
jurisdiction of the local building department. As part of the license
application, the prospective licensee shall submit evidence of
compliance with applicable building standards for hospice facilities.
(3) The physical environment of the hospice facility shall be
adequate to provide the level of care and service required by the
residents of the facility as determined by the department.
(e) A hospice facility may be located within the physical plant of
another health facility.
(1) Notwithstanding subdivision (d) and paragraphs (8) and (9) of
subdivision (b) of Section 129725, a hospice facility located within
the physical plant of another licensed health facility that is under
the jurisdiction of the Office of Statewide Health Planning and
Development, shall meet the building standards for that category of
health facility within which the hospice facility is located, and
plans shall be submitted to the office for review of any new
construction or renovation of these hospice facilities. As part of
the license application, the prospective licensee shall submit
evidence of compliance with the building codes enforced by the Office
of Statewide Health Planning and Development.
(2) The physical environment of the facility shall be adequate to
provide the level of care and service required by the residents of
the facility as determined by the department.
(3) In the event the space used by the hospice facility reverts
back to the facility with which the hospice facility shared the
space, the building standards applicable to the former shared space,
as identified by date of enactment of the standards, shall not change
due solely to the reversion.
(4) A hospice facility that provides inpatient hospice care and is
located within, adjacent to or physically connected to another
health facility shall provide all of the following:
(A) A designated nursing station.
(B) Adequate space for the preparation of drugs with lockable,
secure storage that is accessible only by authorized personnel.
(C) Signage that shall clearly demarcate the hospice facility area
from the facility with which the hospice facility shares space.
(D) Doors for every exit and entrance to the hospice facility.
(E) Contiguous beds within the designated area set aside for the
(f) If a freestanding hospice facility is located on the site of
or is physically connected to a health facility that is under the
jurisdiction of the Office of Statewide Health Planning and
Development or both, the hospice facility shall submit plans for any
new construction or renovation of the hospice facility to the office
for plan review and approval. The Office of Statewide Health Planning
and Development shall review the hospice facility plans to identify
any impacts to the health facility under the office's jurisdiction
that may compromise the health facility's continued compliance with
applicable laws and regulations.
(a) A hospice facility shall provide, or make provision
for, all of the following services and requirements:
(1) (A) Medical direction and adequate staff. Minimum staffing
standards that require at least one registered nurse to be on duty 24
hours per day and a maximum of six patients assigned at any given
time per direct caregiver.
(B) For purposes of this section, any additional direct caregiver
necessary beyond the registered nurse required pursuant to paragraph
(1) may include a registered nurse, as described in Section 2732 of
the Business and Professions Code, a licensed vocational nurse, as
described in Section 2864 of the Business and Professions Code, and a
certified nurse assistant.
(2) Skilled nursing services.
(3) Palliative care.
(4) Social services and counseling services.
(5) Bereavement services.
(6) Volunteer services.
(7) Dietary services.
(8) Pharmaceutical services.
(9) Physical therapy, occupational therapy, and speech-language
(10) Patient rights.
(11) Disaster preparedness. Disaster preparedness plans for both
internal and external disasters shall protect hospice patients,
employees, and visitors, and reflect coordination with local agencies
that are responsible for disaster preparedness and emergency
(12) An adequate, safe, and sanitary physical environment.
(13) Housekeeping services.
(14) Patient medical records.
(15) Other administrative requirements.
(b) The department may adopt regulations that establish standards
for the provision of the services in subdivision (a) and any
additional qualifications and requirements for licensure above the
requirements of this article.
(c) A hospice patient has a right to be informed of his or her
rights, and the hospice facility shall protect and promote the
exercise of these rights. The hospice facility shall comply with the
patients' rights regulation in Section 418.52 of Title 42 of the Code
of Federal Regulations unless the department adopts regulations
establishing alternative standards pursuant to Section 1250.1. In
addition, the hospice facility shall provide each patient with all of
(1) Information at admission to a hospice facility pursuant to
Chapter 3.9 (commencing with Section 1599).
(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
(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.
(d) The hospice facility shall continue to provide services to
family and friends after the patient's stay in the hospice facility
in accordance with the patient's plan of care. These services may be
provided by the hospice services program that operates the hospice
(e) The hospice facility shall demonstrate the ability to meet
licensing requirements and shall be fully responsible for meeting all
licensing requirements, regardless of whether those requirements are
met through direct provision by the facility or under contract with
another entity. The hospice facility's reliance on contractors to
meet the licensing requirements does not exempt the hospice facility
from any requirements or in any way alter the hospice facility's
responsibilities. When a health facility provides services under
contract to a hospice facility, nothing shall preclude the department
from holding the health facility responsible for violations of the
law, if the department determines that the facts also constitute a
separate violation for the health facility providing services under
(f) The hospice facility shall provide inpatient hospice care in
compliance with Section 418.3 and Sections 418.52 to 418.116,
inclusive, of Title 42 of the Code of Federal Regulations until the
department adopts regulations establishing alternative standards
pursuant to Section 1250.1.