Georgia Hospice Rules and Regulations: Licensing and Patient Rights

Hospice care in Georgia is governed by two overlapping sets of rules: the state licensing regulations in Chapter 111-8-37 of the Georgia administrative code, issued by the Department of Community Health (DCH), and the federal Medicare conditions of participation that apply to any hospice billing Medicare or Medicaid. Together, Georgia hospice rules and regulations control who can operate a hospice, who qualifies as a patient, what services must be offered, how facilities and medications must be handled, and what happens when a provider falls short.

Who Can Operate a Hospice in Georgia

No one can operate, establish, or maintain a hospice in Georgia without a license from the Department of Community Health. Even using the word “hospice” to describe services without a valid license is prohibited.¹

The application must be signed by the hospice administrator or the executive officer of the governing body. It has to include the applicant’s name, address, phone number, and business email; proof of ownership such as a certificate of incorporation or other evidence of legal authority to operate in Georgia; a list of counties the hospice plans to serve; and the locations and bed counts of any additional hospice care facilities.

New hospices receive an initial license valid for up to six months, which gives them time to demonstrate they can meet the regulations. Once they show substantial compliance, they become eligible for a regular license. Licenses do not transfer between owners or locations. Any planned change of ownership, lease arrangement, location, name, bed count, or scope of services requires a new application filed at least 30 days before the change takes effect.¹ Knowingly providing false or misleading information on an application is grounds for denial or revocation.

Hospices serving Medicare or Medicaid beneficiaries must also meet the federal conditions of participation and obtain certification for those programs. That certification layers additional clinical, staffing, and reporting requirements on top of the state license.

Who Qualifies for Hospice Care

Under Medicare, a patient qualifies for hospice care when they have a terminal illness with a life expectancy of six months or less if the disease follows its expected course. The hospice’s medical director or a physician on the care team must review the clinical information and provide a written certification to that effect.² That review looks at the primary terminal condition, related diagnoses, current treatments, and the patient’s overall medical picture.

Six months is not a hard cutoff. Patients who live longer can keep receiving hospice care as long as a physician recertifies terminal illness before each new benefit period. Electing hospice does mean stepping away from curative treatment for the terminal condition, because the benefit is built around comfort and quality of life rather than cure.

Patients can revoke their election at any time by filing a signed statement with their hospice. Revocation restores regular Medicare coverage for the remainder of that benefit period, and the patient can re-elect hospice later.³

Required Levels of Care

Every Medicare-certified hospice in Georgia must be able to provide four levels of care, matched to what the patient and family need at any given moment.⁴

Routine home care, the most common level, where the patient is at home with generally controlled symptoms and the hospice team visits on a schedule.⁵
Continuous home care during brief crisis periods when the patient needs predominantly nursing care on a continuous basis at home to manage pain or acute symptoms, with the goal of keeping the patient out of a facility.
General inpatient care, meaning short-term care in a hospital, skilled nursing facility, or hospice inpatient unit for pain or symptom management that cannot be handled elsewhere.
Respite care, a temporary inpatient stay of up to five consecutive days in a Medicare-certified facility so a family caregiver can rest. Unlike the other levels, respite is triggered by caregiver needs rather than a change in the patient’s symptoms.

Georgia’s own rules require providers to inform patients about the levels of care available and any associated charges.⁶

Staffing and Interdisciplinary Team

Federal rules require every hospice to operate with an interdisciplinary group that includes, at minimum, a physician, a registered nurse, a social worker (or marriage and family therapist or mental health counselor), and a pastoral or other counselor. This team develops and updates each patient’s plan of care.⁷

A designated physician must serve as medical director, responsible for the medical component of patient care and for reviewing the clinical information supporting each certification of terminal illness.² The role does not require full-time hours, but its clinical oversight duties are extensive.

Hospices that provide inpatient care directly must provide 24-hour nursing services. When at least one patient is receiving general inpatient care, each shift must include a registered nurse delivering direct patient care.⁸ For home-based care, registered nurses coordinate and deliver services according to the plan of care, and the 24-hour on-site nursing standard applies specifically to inpatient settings.

Volunteers are a required part of hospice operations, not an add-on. Federal rules mandate that volunteer hours equal at least 5% of the total patient care hours provided by all paid employees and contract staff, and the hospice must document the types of volunteer services and the hours worked.⁹

Bereavement Services

Every hospice must maintain an organized bereavement program supervised by a professional with experience in grief or loss counseling. Bereavement services must be available to the family and other individuals identified in the bereavement plan of care for up to one year after the patient’s death.¹⁰ These services are included in the hospice benefit at no additional cost, and specific offerings vary by hospice but commonly include phone calls, mailings, referrals to community grief support groups, and visits from a social worker or chaplain.

Patient Rights Georgia Hospices Must Uphold

Georgia’s hospice regulations require every licensed provider to give patients written and verbal notice of their rights during the initial assessment visit, before care begins.¹¹ Under state rules, those rights include:

Voluntary participation, with the ability to end the hospice relationship at any time.
Informed consent, meaning patients receive only the care they have agreed to and can refuse specific treatments without losing access to the hospice.
Care delivered in a way that preserves the patient’s dignity, privacy, and safety.
Freedom from physical or emotional abuse, neglect, and unnecessary restraints.
Participation in developing and updating the plan of care.
Choice of attending physician, provided the physician agrees to follow the hospice’s policies.
Confidentiality of medical and personal information, consistent with HIPAA privacy rules.¹²
A clear grievance process, with prompt resolution of concerns.
Continued hospice care regardless of ability to pay.

Georgia rules also require hospices to respect religious beliefs and personal customs, accommodate communication needs, and allow family members and legal guardians to be present during inpatient stays unless their presence creates a safety risk.⁶ Federal rules add that the hospice must inform patients about advance directives and distribute written information about applicable state law.¹¹

Facility, Safety, and Medication Standards

Hospices that operate inpatient facilities in Georgia have to meet physical environment and safety requirements. The Georgia Office of the State Fire Marshal conducts Life Safety Code inspections at hospice facilities that participate in Medicare or Medicaid. Some buildings are required by law to have fire alarm and automatic sprinkler systems, and if either system goes down for more than four hours in a 24-hour period, the building must be evacuated or a fire watch established.¹³

Facilities must also comply with the Americans with Disabilities Act, which sets construction and alteration standards for healthcare buildings and requires existing facilities to remove architectural barriers when doing so is readily achievable.¹⁴

Medication storage and handling fall under the Georgia Board of Pharmacy. The vendor pharmacist must set standards for drug labeling, storage, transport, and recordkeeping, and all drugs must be stored with proper temperature, ventilation, moisture control, and security.¹⁵ Hospice emergency drug kits get special scrutiny. They must be sealed to prevent unauthorized access, stored in limited-access areas, and inventoried monthly by a pharmacist from the provider pharmacy. The Board approves on an individual basis which drugs and quantities each hospice can keep in an emergency kit.¹⁶

Inspections, Complaints, and Enforcement

Georgia’s inspection approach depends on federal certification status. Hospices certified under Medicare or Medicaid are exempt from routine on-site state licensure inspections because the federal survey process already examines their operations. The DCH still has authority to inspect any licensed hospice at any time in response to a complaint alleging noncompliance with state rules.¹⁷ Hospices without federal certification undergo periodic state inspections. When deficiencies are found, the hospice must submit an acceptable plan of correction, and failure to do so can trigger enforcement proceedings.¹

Patients, families, or anyone concerned about a Georgia hospice can file a complaint with the DCH’s Healthcare Facility Regulation Division. Complaints can be submitted online through the DCH website, by phone at (800) 878-6442, or by fax at (404) 657-8935.¹⁸ Complaint-based inspections are unannounced and can be triggered by allegations of poor care, neglect, patient rights violations, or unsafe conditions.

Medicare-certified hospices must also participate in the Hospice Quality Reporting Program, submitting data through the Hospice Outcomes and Patient Evaluation tool, the CAHPS Hospice Survey, and Medicare claims data.¹⁹ Hospices that fail to comply face an annual payment update reduction of 4%.²⁰

Penalties for Noncompliance

A hospice that fails to comply with Georgia’s licensing rules faces civil and administrative enforcement by the DCH under the Georgia Administrative Procedures Act.¹ Actions can include fines, probationary conditions on the license, or revocation. Providing false or misleading information on a license application is independently grounds for denial or revocation, even without a patient care failure.

The federal stakes are higher for hospices participating in Medicare or Medicaid. Fraudulent billing can result in exclusion from government healthcare programs, repayment of improperly received funds, and criminal charges. Individual administrators and clinicians responsible for misconduct risk losing their professional licenses through action by their respective licensing boards, on top of any penalties the facility receives.

1
Georgia Secretary of State. Georgia Code of Rules and Regulations 111-8-37 – Rules and Regulations for Hospices
2
eCFR. 42 CFR 418.102 – Condition of Participation: Medical Director
3
eCFR. 42 CFR 418.28 – Revoking the Election of Hospice Care
4
Medicare.gov. Medicare-Certified 4 Levels of Hospice Care
5
eCFR. 42 CFR 418.302 – Payment Procedures for Hospice Care
6
Legal Information Institute. Georgia Comp. R. and Regs. R. 111-8-37-.10 – Patient and Family Rights
7
eCFR. 42 CFR 418.56 – Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services
8
eCFR. 42 CFR 418.110 – Condition of Participation: Hospices That Provide Inpatient Care Directly
9
eCFR. 42 CFR 418.78 – Condition of Participation: Volunteers
10
eCFR. 42 CFR 418.64 – Condition of Participation: Core Services
11
eCFR. 42 CFR 418.52 – Condition of Participation: Patient’s Rights
12
U.S. Department of Health and Human Services. Individuals’ Right Under HIPAA to Access Their Health Information
13
Office of the Commissioner of Insurance and Safety Fire. Healthcare Facilities (CMS)
14
U.S. Department of Justice. Access to Medical Care for Individuals with Mobility Disabilities
15
Georgia Secretary of State. Georgia Rules and Regulations Chapter 480-24 – Nursing Homes, Long Term Care Facilities and Hospice Emergency Drug Kits
16
Legal Information Institute. Georgia Comp. R. and Regs. R. 480-24-.07 – Hospice Emergency Drug Kits
17
Legal Information Institute. Georgia Comp. R. and Regs. R. 111-8-37-.05 – Inspections and Investigations
18
Georgia Department of Community Health. HFRD File a Complaint
19
Centers for Medicare and Medicaid Services. HQRP Requirements and Best Practices
20
Centers for Medicare and Medicaid Services. Hospice Quality Reporting Program