Initial Application Packet
A State license is required to operate as a Hospice Facility (HOFA) in California. A HOFA means "a health facility licensed pursuant to this chapter 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 Health and Safety Code (HSC) section 1339.40, and is operated by a provider of hospice services that is licensed pursuant to HSC Section 1751 and certified as a hospice pursuant to Part 418 of Title 42 of the Code of Federal Regulations."
Attention Hospice Applicants! Please review [AFL 21-53 ] This AFL notifies hospices of the chaptering of SB 664 (Chapter 494, Statutes of 2021) that establishes a moratorium on hospice licensure, prohibiting the California Department of Public Health (CDPH) from issuing a new hospice license on or after January 1, 2022, and until 365 days from the date the California State Auditor (CSA) publishes a report on hospice licensure. Applications for licensure of a multiple location of an existing hospice, a change of geographical service area, or a change of location outside of a hospice's approved geographical service area will be subject to the moratorium.
Application After January 1, 2022
Individuals or entities interested in applying for hospice licensure after January 1, 2022, should begin by submitting an exception request. This consists of submitting a written justification and supporting documentation to demonstrate need based on geographic concentration to CAB. If CAB determines there is a need based on geographic concentration, CAB will notify the applicant that they may submit an application.
To apply for an Initial license, you must complete the required application packet.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process. The Sample Application Packet is a visual aid that displays a sample of the completed forms contained in the application packet.
Application Packet Forms
Applicants must complete and submit the following forms in the application packet:
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Licensing and Certification Program
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377