Executive Commentary │ An Open Letter Regarding California Emergency Regulations for Licensing Hospice Agencies

Posted: July 1, 2026

A message from José Domingos

To the California Department of Public Health, California State Senate/Assembly, California Attorney General, CMS San Francisco Location:

As a nationally recognized healthcare accreditation organization, Accreditation Commission for Health Care, Inc. (ACHC) released its first standards for the accreditation of hospice agencies in 1996. ACHC is authorized by the Centers for Medicare & Medicaid Services (CMS) to evaluate hospice and home health agencies (among other settings) for compliance with federal and state regulations for safety and quality of care and has held this deeming authority continuously since 2009. Additionally, we are approved by the California Department of Public Health (CDPH) to conduct licensure surveys following departmental approval of applications.

ACHC’s role in the licensure process has been to provide validation that the information approved by CDPH (including location and current lease, staffing, and geographic service area among other aspects of the application) is current and accurate. In the course of this validation work, we have communicated concerns about significant regulatory gaps in the licensure process to CDPH, to members of the State Senate and Assembly, to Attorney General Bonta, and to the CMS Location overseeing the State Agency.

On June 11, 2026, the California Department of Public Health filed emergency regulations establishing the first comprehensive licensing framework for hospice agencies in California.

We acknowledge our alignment with CDPH noting ACHC recommendations that are found in the Proposed Regulations:

• Each county in a hospice’s proposed service area must also demonstrate “unmet need” for hospice services using a formula specified in the regulations.
• Administrators and DPCS may manage only one hospice agency, with an exception allowing concurrent employment at up to two hospices if both are located in the same rural area.
• Medical Directors may manage only one hospice, with a rural area exception allowing up to three.
• The Administrator or Administrator Designee must be on the premises of the hospice or accessible by telecommunication during their scheduled work hours.
• Each hospice is required to maintain an established place of business consisting of unshared commercial office space where the licensee has exclusive possession, located in a commercial building owned or leased by the licensee for a minimum of 12 consecutive months.
• The office must include permanently attached exterior and interior signage identifying the hospice, and an active business telephone line answered 24 hours a day, seven days a week.
• The office is required to secure storage for patient medical records, medications, and personnel records.

Most of our recommendations have been addressed by the recent action taken by CDPH to define emergency Proposed Regulations aimed at addressing hospice fraud indicators in the state. We are grateful on behalf of all Californians that the Proposed Regulations will close many of the existing loopholes we identified.

Hospice fraud and abuse are not limited to California. There is more work to be done nationwide. ACHC has offered additional recommendations that would impact Medicare certification, including requiring a minimum number of active patients to be considered operational; additional surveys for agencies with high live discharge rates (>20%) or unusually long length of stay (LOS >180 days); and a return survey within six to eight months of initial certification to demonstrate operational compliance.

We deeply appreciate our positive working relationship with CDPH and other state and federal partners. Together we support the elimination of fraud and abuse, ensuring safety and quality of care are available to all Americans.

Sincerely,