New Jersey Hospice Regulations: Licensing, Care Levels, and Oversight

Hospice providers in New Jersey operate under two sets of rules at once. State licensing standards in N.J.A.C. 8:42C govern who may open and run a hospice, and the federal Medicare Hospice Conditions of Participation in 42 CFR Part 418 govern any provider that bills Medicare. New Jersey hospice regulations require a written license from the New Jersey Department of Health (NJDOH) before a hospice may accept its first patient, and Medicare-billing hospices must clear a second layer of federal requirements on top of that. Missing a piece on either side can mean daily fines, loss of Medicare reimbursement, or a forced shutdown.

Licensing a Hospice in New Jersey

No hospice may accept patients in New Jersey until NJDOH issues written approval or a license.¹ The application fee is $2,000 and nonrefundable, and the same $2,000 applies every year at renewal.² A hospice that operates an inpatient care unit pays an additional $1,500 plus $15 per licensed bed. Renewal falls on the original licensure date each year, and a lapsed license counts as operating without one.

Before a license issues, NJDOH inspectors survey the facility to confirm compliance with N.J.A.C. 8:42C, reviewing governance, administrative systems, quality assurance, and the physical plant. Any deficiencies have to be corrected first. After the license is granted, NJDOH may return at any time, including a visit to a patient’s home with the patient’s consent, to review records and care.¹

Every licensed hospice must keep a physical office in the state and follow the New Jersey Uniform Construction Code for any newly built or renovated patient care areas.³ Written policies covering infection control, emergency preparedness, and patient rights are required and inspected.

Who Can Run and Staff a Hospice

An administrator hired after June 21, 1999 must hold either a master’s degree in administration or a health-related field with at least two years of supervisory experience in hospice or health care, or a bachelor’s degree in one of those fields with at least four years of supervisory experience.⁴

Beyond the administrator, every hospice needs an interdisciplinary team: physicians, registered nurses, social workers, and counselors. Physicians and nurses must hold active New Jersey licenses. The medical director is personally responsible for the medical component of the program, including reviewing clinical information and certifying that a patient’s life expectancy is six months or less.⁵ Social workers must be state-licensed. Medical social services and bereavement counseling must be provided by the hospice’s own employees, with only limited exceptions for contracting.

Home Health Aide Training

Certified home health aides (CHHAs) working in hospice have to satisfy both state and federal training rules. Federal hospice-aide training runs at least 75 hours, with a minimum of 16 hours of classroom instruction followed by at least 16 hours of supervised practical training.⁶ New Jersey’s own CHHA certification requires 76 hours (60 classroom and 16 clinical), a skills demonstration, a written exam, and a background check.⁷

A registered nurse has to visit each hospice patient’s home at least once every 14 days to assess the quality of aide services.⁸ Any CHHA who goes 24 consecutive months without providing compensated services has to complete a new training program before returning to work.⁶

Criminal Background Checks

Under N.J.S.A. 26:2H-83, NJDOH will not certify a nurse aide or personal care assistant until a criminal history check clears through both the FBI and the New Jersey State Police. Disqualifying convictions include crimes involving danger to a person (homicide, assault, kidnapping, sexual assault, robbery), offenses against family members or children, theft, and most controlled-substance offenses. A follow-up federal records check is required at least every two years as a condition of recertification.⁹

A disqualifying conviction is not always a permanent bar. The statute lets an applicant present “clear and convincing evidence” of rehabilitation to the Commissioner of Health, but that burden falls entirely on the applicant.

The Four Levels of Hospice Care

Every Medicare-certified hospice must be able to deliver four levels of care and match its staffing, resources, and billing to whichever level a patient needs at any given moment.¹⁰

Routine home care, the most common level, for stable patients whose symptoms are controlled, usually delivered at home.
Continuous home care, a crisis-level service that provides predominantly nursing care in the home, often for extended hours, to manage uncontrolled pain or symptoms.
General inpatient care, also crisis-level, delivered in a hospital or skilled nursing facility when symptoms cannot be controlled at home.
Inpatient respite care, temporary care in a nursing home, hospice inpatient facility, or hospital so a primary caregiver can rest, limited to five consecutive days per stay.¹¹

Documentation has to clearly support the level billed, because CMS audits these classifications closely.

Care Plans, Pain Management, and Required Services

Every hospice patient has to have an individualized care plan developed by the interdisciplinary team, reviewed and updated at least every 15 days.⁵ Patients and families must be involved in shaping the plan.

Opioid Prescribing

New Jersey layers its own prescribing rules on top of federal ones. Under N.J.S.A. 24:21-15.2, an initial opioid prescription for acute pain cannot exceed a five-day supply and must be for the lowest effective dose of an immediate-release formulation. Before issuing any initial opioid or Schedule II controlled substance prescription for pain, the prescriber must take a full medical history including substance use history, conduct a physical examination, develop a treatment plan, and check the state’s Prescription Monitoring Program.¹² Hospices also follow federal DEA rules for storing, tracking, and disposing of controlled substances.

Bereavement

Hospice obligations continue after a patient dies. Under the Medicare Conditions of Participation, bereavement services must be monitored and provided for at least 13 months following the death. The program has to be supervised by a qualified professional with grief or loss counseling experience, and it must conduct an initial assessment of family members, develop an individualized bereavement plan, and specify how often services will be delivered. Hospices serving patients in skilled nursing facilities must coordinate bereavement duties with the facility.

Volunteers

Federal rules require every Medicare-certified hospice to run a volunteer program in which volunteer hours equal at least five percent of the total patient-care hours provided by paid employees and contract staff.¹³ The hospice has to keep records of the type of services and time worked. Falling below five percent is a survey deficiency.

Patient Rights and Advance Directives

Federal law gives hospice patients specific rights that the provider must communicate in writing before care begins: the right to effective pain management, to be involved in developing the care plan, to refuse care or treatment, to choose an attending physician, and to be free from mistreatment, neglect, or abuse.¹⁴ The information must be delivered verbally and in writing, in a language the patient understands, during the initial assessment visit.

New Jersey adds its own advance directive rules. A hospice must give patients written information about their right to accept or refuse treatment and to create an advance directive at the time care first begins.¹⁵ Each medical record must note whether an advance directive is on file, and providers cannot discriminate in care based on whether one exists.

New Jersey also uses the Practitioner Orders for Life-Sustaining Treatment (POLST) form. Signed by the patient’s attending physician, advanced practice nurse, or physician assistant, a POLST translates a patient’s wishes about life-prolonging interventions into medical orders that follow the patient across care settings, hospice included.¹⁶ For hospice staff, a POLST is a standing medical order to be honored, not paperwork to file away.

Medicare Certification, Eligibility, and Discharge

To qualify for the Medicare hospice benefit, the patient’s hospice physician and regular doctor (if applicable) must certify that the patient is terminally ill with a life expectancy of six months or less; the patient must accept palliative care instead of curative treatment; and the patient must sign a statement electing hospice. After the initial six-month period, care continues as long as a hospice physician or medical director recertifies the terminal prognosis following a face-to-face visit.¹¹

A hospice may discharge a patient in only three situations: the patient moves out of the service area or transfers to another hospice; the hospice determines the patient is no longer terminally ill; or the patient’s or household member’s behavior is so disruptive that it seriously impairs care. Discharge for cause has strict procedural safeguards. The hospice must first notify the patient, make a genuine effort to resolve the problem, confirm that the discharge is not simply because the patient is using necessary services, and document every step in the record.¹⁷

Oversight, Surveys, and Complaints

NJDOH regulates hospices through routine inspections and unannounced surveys. Inspectors review operational procedures, patient records, and quality of care. When deficiencies are found, the hospice must submit a corrective action plan and undergo a follow-up inspection under N.J.A.C. 8:43E-2.¹ For Medicare- or Medicaid-participating hospices, CMS adds a second layer of oversight through the Conditions of Participation, and NJDOH conducts those surveys and complaint investigations on CMS’s behalf.⁵ Falling out of compliance with federal conditions can mean exclusion from Medicare and Medicaid reimbursement.

Medicare-certified hospices must also participate in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to receive their full Annual Payment Update, contracting with a CMS-approved vendor to administer it. Hospices with fewer than 50 survey-eligible decedents or caregivers during the reference period can apply for a size exemption, and newly certified hospices that received their certification number on or after January 1, 2026 receive an automatic one-time exemption for newness.¹⁸

Patients, staff, and members of the public can file complaints through the NJDOH online complaint form or by calling the Department of Health Complaint Hotline at 800-792-9770, which runs 24 hours a day. Callers who want to stay anonymous should use the hotline rather than the online form, which requires contact information.¹⁹

Penalties for Noncompliance

NJDOH’s penalty schedule under N.J.A.C. 8:43E-3.4 varies with the violation. Operating without a license draws $1,000 per day. An isolated patient-care or physical-plant violation that poses a risk to health or safety is $500, but widespread deficiencies or a direct risk of harm to a patient’s physical or mental health jump to $1,000 per violation per day.²⁰

Repeat violations within 12 months or on successive annual inspections escalate: $500 per violation per day for the first repeat, double the original fine for the second, and triple for the third and beyond.²⁰ Hospices generally get 30 days either to correct the problem or to request a hearing before a penalty takes effect.²¹ Miss that window and the Department can move ahead with fines, suspension, or revocation.

For facilities operating without any license at all, the Commissioner may issue a cease-and-desist order under N.J.A.C. 8:43E-3.11.²² Medicare and Medicaid violations can result in exclusion from those programs, and persistent fraud, neglect, or misrepresentation of services may be referred to the New Jersey Attorney General’s Office for prosecution.

1
Legal Information Institute. New Jersey Admin Code 8:42C-2.5 – Licensure
2
Justia. New Jersey Code 26:2H-80 – Licensing of Hospice Care Program
3
Legal Information Institute. New Jersey Admin Code 8:42C-11.4 – Patient Care Area Requirements for Inpatient Hospice Care Units
4
Legal Information Institute. New Jersey Admin Code 8:42C-4.3 – Qualifications of the Administrator
5
eCFR. 42 CFR Part 418 – Hospice Care
6
eCFR. 42 CFR 418.76 – Condition of Participation: Hospice Aide and Homemaker Services
7
Jobs that Care New Jersey. Certified Home Health Aide
8
Centers for Medicare & Medicaid Services. RN Supervision of Hospice Aide Services
9
Justia. New Jersey Code 26:2H-83 – Criminal History Record Background Checks
10
Medicare.gov. Hospice Levels of Care
11
Medicare.gov. Hospice Care
12
Justia. New Jersey Code 24:21-15.2 – Limitation on Amount of Opioid Initially Prescribed Under Certain Circumstances
13
eCFR. 42 CFR 418.78 – Condition of Participation: Volunteers
14
eCFR. 42 CFR 418.52 – Condition of Participation: Patient’s Rights
15
Legal Information Institute. New Jersey Admin Code 10:49-9.15 – Advance Directives
16
State of New Jersey Department of Health. Practitioner Orders for Life-Sustaining Treatment (POLST)
17
eCFR. 42 CFR 418.26 – Discharge from Hospice Care
18
CAHPS Hospice Survey. FAQs
19
New Jersey Department of Health. How to File a Complaint
20
Legal Information Institute. New Jersey Admin Code 8:43E-3.4 – Civil Monetary Penalties
21
Justia. New Jersey Code 26:2H-13 – Violations, Penalties, Notice, Hearing
22
Legal Information Institute. New Jersey Admin Code 8:43E-3.11 – Cease and Desist Order