Hospice Facility​
Change of Certification Application Packet

A State license is required to operate as a Hospice Facility (HOFA) in California. Pursuant to Health and Safety Code (HSC) section 1250(n), 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 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." ​

To apply for ​Medi-Cal and/or Medicare certification to a licensed health facility, 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 provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for certification.

Please refer to the following links to get started:

• Provider Instructions​
  
• Provider Ch​​ecklist 
  

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​