Florida Hospice Regulations: Licensing, Staffing, and Inspections

Florida hospice regulations require any provider to first obtain a certificate of need and then a state license from the Agency for Health Care Administration (AHCA) before serving patients, and to operate under a combined framework of Florida statutes, state administrative rules, and federal Medicare conditions of participation. Those rules govern how hospices are approved, what services they must deliver, who can staff them, how patients are protected, and what happens when something goes wrong.

Getting Approved To Operate

Florida still uses a certificate of need (CON) process to regulate the supply of hospice services. Both new hospice programs and freestanding inpatient hospice facilities require a CON before an applicant can even ask for a license.¹

AHCA runs two batching cycles per year. A letter of intent must be filed at least 30 days before the full application, and the agency decides within 60 days of a complete application.² A narrow exemption applies to programs established by entities sharing a controlling interest with certain not-for-profit retirement communities, but most applicants go through full CON review.¹

Once a CON is in hand, the provider applies for a hospice license through AHCA.³ The application must include a detailed plan for home-based, residential, and inpatient services covering:

The estimated average number of terminally ill patients served each month.
The geographic service area.
Services provided directly or through contracts with other providers.
The number and disciplines of professional staff, plus names and qualifications of any contractors.
A plan for attracting and training volunteers.
An implementation timeline: home care must begin within 3 months of licensure, inpatient care within 12 months.

The license application fee cannot exceed $1,200 per two-year period.⁴ Missing the startup deadlines is fatal. AHCA will revoke the license of any hospice that fails to have home care running within 3 months or inpatient care running within 12 months.⁵

Services a Hospice Must Provide

Florida law requires every hospice to deliver its core services directly through its own team rather than contracting them out. Those core services are nursing, social work, pastoral or other counseling, dietary counseling, and bereavement counseling. Physician services are the one core component that may be provided directly or by contract.⁶ Contracted staff can supplement employees during peak loads or extraordinary circumstances, but that is the exception.

Federal rules echo the point. Under Medicare conditions of participation, a hospice must directly provide nursing, medical social services, and counseling through its employees. Contracting for highly specialized nursing is allowed only when providing it in-house would be impractical and prohibitively expensive.⁷

The Plan of Care

Every admitted patient must receive a professional assessment covering physical, social, psychological, spiritual, and financial needs. That assessment becomes the foundation for an individualized written plan of care.⁸ The plan identifies the primary caregiver, documents diagnosis and preferences, outlines needed services, and describes emergency procedures. A designated nurse coordinates the plan for each patient and family.

Plans aren’t static. The hospice must continuously reassess and update, coordinating with the patient’s attending physician.⁸ Federal rules also require interventions for pain and symptom management, a detailed statement of the scope and frequency of services, and measurable expected outcomes.⁹

Respite Care

When a family caregiver needs a break, the hospice can arrange short-term inpatient respite at a Medicare-approved facility such as a hospital, nursing home, or hospice inpatient unit. Each stay is limited to 5 days, though a patient can receive respite more than once on an occasional basis. Medicare covers these stays, and the patient pays 5 percent of the Medicare-approved amount.¹⁰

Staffing and Personnel Rules

Florida statutes require every licensed hospice to have a medical director licensed as an M.D. or D.O. under Chapter 458 or 459, responsible for directing medical care and treatment. Each hospice must also employ a full-time registered nurse, licensed under Part I of Chapter 464, who coordinates implementation of the plan of care for every patient.¹¹

The medical director’s job extends past administration. Under Florida administrative rules, the medical director must hold admission privileges at one or more hospitals commonly serving the hospice’s service area, serve on the care team, and establish written protocols for symptom control.¹²

Volunteers

Every hospice must maintain trained volunteers providing both administrative support and direct patient care. Volunteer hours must equal at least 5 percent of the total patient care or administrative hours worked by all paid employees and contract staff combined. The hospice must track volunteers, their hours, and tasks performed.¹¹ The same 5 percent threshold appears in the federal Medicare conditions of participation, so it applies regardless of payer.¹³

Background Screening

Florida requires Level 2 background screening for hospice personnel under Section 408.809.¹⁴ Level 2 involves fingerprinting and searches of both state and federal criminal databases, and must be completed before an employee begins providing care.

Hospice Aides

Aides providing hands-on patient care face separate federal requirements. An aide cannot furnish services until passing a competency evaluation covering communication, vital signs, infection control, emergency procedures, and safe personal hygiene technique. Parts of the evaluation must involve direct observation of the aide with an actual or simulated patient. Once working, every aide must receive at least 12 hours of in-service training per 12-month period, which can occur while the aide is furnishing care.¹⁵

Facility, Fire, and Infection Standards

Inpatient facilities must comply with the Florida Building Code, which classifies them as Institutional Occupancy, Group I-2. New inpatient units must meet National Fire Protection Association Life Safety Code 101, Chapter 18, for new health care occupancies; existing facilities follow Chapter 19.¹⁶

Inpatient facilities must also provide a Type III essential electrical system with emergency backup power meeting specific generator standards. Patient rooms must support nursing care and include easily activated call systems. Facilities must meet accessibility requirements under Chapter 11 of the Florida Building Code, which incorporates federal ADA standards along with Florida-specific provisions.¹⁷

Federal conditions of participation require a documented infection control program protecting patients, families, visitors, and staff. It must include surveillance and identification of infectious diseases, a plan for corrective action, and integration with the hospice’s quality improvement program. Hospices must also provide infection control education to employees, contracted providers, patients, and family caregivers.¹⁸

Patient Rights and Advance Directives

Every hospice must inform patients of their rights before furnishing care. During the initial assessment visit, the hospice must provide both spoken and written notice of patient rights and responsibilities in a language and manner the patient understands.¹⁹

Hospices must also distribute written information about their advance directive policies, including a description of applicable Florida law. That means explaining how living wills, healthcare surrogates, and do-not-resuscitate orders work within hospice care. A hospice cannot condition care or discriminate based on whether a patient has an advance directive.¹⁹

Medicare Hospice Benefit

Most Florida hospice patients are covered through the Medicare hospice benefit under Part A. Three conditions must be met: two physicians (the hospice doctor and the patient’s regular doctor, if they have one) must certify a life expectancy of 6 months or less, the patient must accept comfort-focused care rather than curative treatment for the terminal illness, and the patient must sign a statement electing the benefit.¹⁰

The 6-month prognosis is not a hard cutoff. After the initial certification period, care continues as long as the hospice medical director or doctor recertifies, following a face-to-face visit, that the patient remains terminally ill.¹⁰

Coverage is broad: physician and nursing care, medical equipment and supplies, prescription drugs for symptom management, hospice aide services, therapy, social work, dietary counseling, and grief counseling for the patient and family. Out-of-pocket costs are minimal: up to $5 per prescription for outpatient medications related to the terminal illness, and 5 percent of the Medicare-approved amount for inpatient respite.²⁰

Quality Reporting

Medicare-certified hospices must participate in the Hospice Quality Reporting Program (HQRP). A hospice that fails to submit required quality data by CMS deadlines faces a 4-percentage-point reduction to its annual payment update, cutting reimbursement rates.²¹

As of October 2025, hospices must submit data using the Hospice Outcomes and Patient Evaluation (HOPE) tool, which replaced the earlier Hospice Item Set. HOPE requires admission, discharge, and update visit records submitted through the Internet Quality Improvement Evaluation System (iQIES). To stay compliant, a hospice must achieve acceptance of at least 90 percent of HOPE records within 30 days of the event date. Hospices must also participate in the CAHPS Hospice Survey each calendar year, which measures patient and family experience.²¹

Inspections and Penalties

AHCA conducts routine and unannounced surveys that assess patient care, staffing, facility conditions, and recordkeeping. Hospices submit utilization reports for each six-month period by set deadlines and file condition compliance reports annually by April 1.²

When a survey uncovers deficiencies, the hospice must develop and follow a corrective action plan. For persistent problems or serious violations, AHCA can impose administrative fines up to $5,000 per violation, suspend new admissions, or suspend or revoke the license.²² Any intentional or negligent act by the hospice or its employees that materially affects a patient’s health or safety is independent grounds for enforcement. AHCA also investigates complaints filed by patients, families, or staff, which can trigger additional unannounced inspections.

Federal enforcement runs on a separate track. CMS can impose civil money penalties of up to $10,000 per day for each day a hospice is out of compliance with one or more conditions of participation. Penalties can be assessed on a per-day or per-instance basis, though CMS cannot impose both types simultaneously for the same deficiency.²³ In cases involving immediate jeopardy to patient safety, CMS can terminate Medicare certification, cutting off the program’s primary revenue stream.

State and federal remedies are cumulative. A single violation can produce AHCA fines and separate CMS civil money penalties, so a Florida hospice effectively operates under two independent oversight systems with their own inspection schedules, standards, and consequences.²²

1
The Florida Senate. Florida Code 408.036 – Projects Subject to Review
2
Florida Agency for Health Care Administration. Certificate of Need (CON) Program Overview
3
Florida Agency for Health Care Administration. Hospice FAQ
4
Online Sunshine. Florida Code 400.605 – Licensure; Fees
5
Online Sunshine. Florida Code 400.606 – License Application
6
Online Sunshine. Florida Code 400.609 – Services
7
eCFR. 42 CFR 418.64 – Condition of Participation: Core Services
8
Online Sunshine. Florida Code 400.6095 – Patient Admission; Assessment; Plan of Care
9
eCFR. 42 CFR 418.56 – Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services
10
Medicare.gov. Hospice Care
11
Online Sunshine. Florida Code 400.6105 – Staffing and Personnel
12
Legal Information Institute. Florida Administrative Code 59A-38.008 – Medical Direction
13
eCFR. 42 CFR 418.78 – Conditions of Participation: Volunteers
14
Florida Senate. Florida Code 400.6065 – Background Screening
15
eCFR. 42 CFR 418.76 – Condition of Participation: Hospice Aide and Homemaker Services
16
UpCodes. Florida Building Code – Hospice Inpatient Facilities and Units and Hospice Residences
17
Florida Building Commission. Florida Accessibility Code for Building Construction – Chapter 11
18
eCFR. 42 CFR 418.60 – Condition of Participation: Infection Control
19
eCFR. 42 CFR 418.52 – Condition of Participation: Patient’s Rights
20
Medicare.gov. Medicare Hospice Benefits
21
Centers for Medicare & Medicaid Services. Hospice Quality Reporting Program (HQRP) Quick Reference Guide
22
Online Sunshine. Florida Code 400.607 – Denial, Suspension, Revocation of License; Administrative Fine
23
Centers for Medicare and Medicaid Services. Hospice Program Integrity Enforcement Remedies Guide