​Hospice Emergency Regulation Questions & Answers​

Hospice Emergency Regulations

Do the hospice emergency regulations published by CDPH on June 22, 2026, apply to existing, licensed hospice agencies?​​

Yes. The emergency regulations published by CDPH on June 22, 2026, apply to both new hospice agencies applying for licensure and existing hospice agencies licensed prior to June 22, 2026.

If the hospice emergency regulations apply to existing, licensed hospice agencies, is there a grace period for existing agencies to come into compliance?

No. Emergency regulations are effective the date they are published.  When CDPH performs inspections of hospice agencies, CDPH will be checking to ensure that the hospice agency is in compliance with the emergency regulations.  A hospice agency not in compliance with the regulations will be issued a deficiency and asked to submit a plan of correction. 

Can my hospice submit a program flex request for requirements contained in the hospice emergency regulations?

Yes.  The program flex request should be submitted through the CDPH Centralized Program Flex Unit.​​

Geographic Service Area (GSA)

If a currently licensed hospice agency has an approved GSA outside the 2-hour window prescribed in the new emergency regulations, does the licensed hospice need to update their GSA?

Yes. The 2-hour GSA as prescribed in Section 74820 applies to both new and existing hospice agencies.  All hospices must re-calculate their GSA to ensure that they meet the new 2-hour GSA. If a hospice agency needs to update their GSA, it must submit a complete Change of GSA application packet to the Centralized Applications Branch. Please refer to the provider instructions and checklist found on the Hospice Agency Change of Geographical Service Area Application Packet website.  

Do multiple locations tied to the parent location extend the 2-hour GSA?

No.  Multiple locations tied to the parent location do not extend the 2-hour GSA.  Per Section 74820(c), the 2-hour GSA is measured from the licensed parent agency office. This ensures that timely care is being provided and adequate training and oversight are being provided by the licensed parent agency.  If a hospice agency wants to keep their existing multiple locations that are outside the 2-hour GSA, the agency will need to apply for a new license for that location. 

If my new GSA takes me partially into a county, can I service the entire county?

No. Hospice agencies may only provide services within their designated 2-hour service area as prescribed in Section 74820.

Hospice Management

I am currently a hospice administrator, director of patient care services, or a medical director for multiple hospice agencies. Do the emergency regulations apply to me?

Yes. Hospice administrators (Section 74876) and directors of patient care services (Section 74852) may only work for one hospice agency. However, if you work in a rural area, you may work for up to two hospice agencies if both hospice agencies reside in the same rural area.

Hospice medical directors (Section 74856) may only work for one hospice agency. However, if you work in a rural area, you may work for up to three hospice agencies if all three agencies reside in the same rural area. 

If I hold a management position at one hospice agency, can I work for another hospice agency in a non-management position?

No. Hospice administrators, directors of patient care services, and medical directors may only work for one hospice agency. If you are an administrator or director of patient care services in a rural area, you may work for up to two hospice agencies if the two agencies are within the same rural area. If you are a medical director, you may work for up to three hospices agencies if the three agencies are within the same rural area.

Can a hospice physician (not a medical director or designee) be employed by more than one hospice agency? 

Yes. The limit pursuant to Section 74856(f) only applies to the physicians designated as the hospice's medical director and medical director designee.

Are providers required to report management vacancies in writing to CDPH as soon as they occur or once new management personnel are hired?

As stated in Section 74828(b), a licensee must report a change to CDPH by submitting an application within 10 business days whenever there is a change to the hospice's management personnel. When reporting the change, the licensee must provide the information on or with the application pursuant to Section 74812(c)(1) through (4), (8), (9), (11) through (13), and (23) through (30), as applicable. This means that within 10 days of losing management personnel, the hospice must notify CDPH. Additionally, the hospice must notify CDPH within 10 days of hiring new management personnel.

Nursing

Can you please provide clarification regarding the 12 or fewer nurse-to-patient ratio contained in Section 74848?

CDPH is making significant changes to the language in Section 74848. The 12 or fewer nurse-to-patient ratio contained in this section was intended to apply to RN case managers only. CDPH will enforce this requirement to apply to RN case managers only. 

Will compliance be evaluated based on each RN case manager's assigned caseload at a given point in time, or based on the agency's overall staffing model and its ability to provide appropriate patient care? 

The nurse-to-patient ratio will be evaluated based on each RN case manager's assigned caseload at a given point in time. RN case managers should never be assigned more than 12 cases at any given time. 

Does a licensed RN need to personally answer every after-hours call, or may a non-clinical answering service or call center receive the initial call and promptly conference or transfer the caller to the on-call RN when clinical assessment is needed?

Hospice agencies are permitted to use answering services to triage after-hours calls; however, a licensed nurse must be available to appear in person within 2 hours pursuant to Section 74820(a) if a visit is required.

Medical Records

Do currently licensed hospice agencies need to submit a written request to CDPH to store hard copy patient medical records at an off-site storage facility?

Yes. Pursuant to Section 74896(p), all hospice agencies must submit a written request to the Department to store hard copies of patient medical records at an off-site facility.   

Do currently licensed hospices who use an EMR need to submit a written request and obtain approval from the Department to store a physical server off the Hospice's premises or to use a hybrid model of storing data?

Yes. Pursuant to Section 74900(c), all hospice agencies must submit a written request to the Department to store data on a server off the hospice's premises, or to use a hybrid model of storing patient medical records.