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Health care Facility Licensing and Certification

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Phone: (916) 552-8632

For application status requests, please include the following in your email:

  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Number

Hospice Agency
Change of Medical Director Application Packet

A State license is required to operate as a Hospice Agency in California. A Hospice 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," pursuant ​to Health and Safety Code (HSC) section 1746(d). Refer to HSC section 1749 for information regarding licensure requirements.

To report a Change of Medical Director, you must complete the required application packet. Refer to California Hospice & Palliative Care Association Standards of Quality Hospice Care, 2003 for information regarding the medical director.

Additionally, a hospice agency shall submit to the department information on whether its medical director, or contracted medical director, is certified as a hospice medical director according to the requirements established by the Hospice Medical Director Certification Board, or certified in hospice and palliative medicine according to the requirements established by a member board of the American Board of Medical Specialties, or by the American Osteopathic Association, or an equivalent organization as determined by the department.

Legislation updates:

  • Assembly Bill (AB) 2673 – Expansion of Hospice Agency Licensure Requirements Oversight, and Enforcement, in addition to Health and Safety Code (HSC) section 1749 requires a hospice agency to have an administrator,  administrator designee,  director of patient care services (DPCS),  director of patient care services designee (DPCSD), and medical director or contracted medical director. Each management personnel must submit an Applicant Individual Information - HS 215A form, a resume, and a list of hospice agencies that the individual is currently serving as management personnel. The hospice agency must submit all the above information to CDPH as part of the initial hospice application, within ten (10) business days of a change in management personnel, and currently licensed hospice agencies on a one-time basis no later than March 31, 2023. The California Department of Public Health (CDPH) must use this information to verify professional licensure status of these individuals and may verify their association with the hospice agency or their work history. Verification may include contacting hospice agency personnel or previous employers.​

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

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

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