Establishing a Hospice Agency

Purpose: This procedure describes the steps to become a licensed and certified hospice agency. Each site providing hospice services must be separately licensed. The North Carolina Medical Care Commission has rulemaking authority for hospice. The statutes that apply to hospice agencies are General Statute 131E-200 through 207 and the licensure rules are under Title 10A of the North Carolina Administrative Code (10A NCAC 13K).

Please be aware that there may be variations in the process since individual projects may have special circumstances. The flow chart is intended to be a general guide to aid the applicant in completing the overall project.

Contacts: For questions regarding any part of this process, please contact the appropriate sections of the N.C. Division of Health Service Regulation:

Acute and Home Care Licensure and Certification Section 919-855-4620
Certificate of Need Section 919-855-3873
Medical Facilities Planning Section 919-855-3865

Procedure Summary: In order to operate a hospice agency in North Carolina, an applicant first reviews the State Medical Facilities Plan (SMFP) to determine if there is a projected need. If the SMFP does not indicate the need for an additional agency, no certificate of need can be issued for a new hospice agency. If the SMFP indicates the need for an additional hospice agency, the applicant must apply for a certificate of need. Applicants successfully obtaining a certificate of need must then apply for and obtain a license. Steps to obtain certification for Medicare and Medicaid are taken after the agency is licensed and in operation.


  1. Review the State Medical Facilities Plan: Medical Facilities Planning Section
    1. Applicants can learn the number of hospice agencies needed in the annual State Medical Facilities Plan (SMFP), which is published for each calendar year and which specifies where in the state they are needed.
    2. Applicants can also find the certificate of need review schedule and deadline for submittal of applications for these agencies, if there is a projected need, in the SMFP. No one may develop a new hospice agency without first obtaining a certificate of need. A certificate of need cannot be issued if the SMFP does not show a need for the hospice agency in the county where it is proposed.
  2. Obtain a Certificate of Need: Certificate of Need Section
    1. The applicant submits a certificate of need application for the proposed hospice agency according to the review schedule outlined in the SMFP.
    2. The Certificate of Need (CON) Section advertises a written public comment period and local public hearing. Within 30 days of the beginning of the review period, written comments may be filed by any person, including the applicant, regarding the proposals under review.
    3. A public hearing is conducted by the CON Section within 30 to 50 days from the beginning of the review period, at which time the applicant is given the opportunity to respond to written comments submitted to the CON Section and inquiries made at the hearing.
    4. A decision to approve or disapprove an application is made by the CON section within 150 days of the beginning of the review period.
    5. A certificate of need is issued 35 days after the date of approval if a petition for a contested case hearing is not filed.
    6. After a certificate of need is issued, the applicant contacts the Acute and Home Care Licensure and Certification Section about its requirements for the development of a hospice agency.
  3. Obtain a license: Acute and Home Care Licensure and Certification Section
    1. The applicant requests a license application from the section. Since agencies may provide one or more home care services, a multi-purpose license application is used and a multi-program license may be issued (i.e., some facilities may be hospice only, while others may serve multiple purposes like home health and hospice). The applicant submits a completed application to the section.
    2. The section reviews the application for completeness.
    3. An initial on-site licensure survey is scheduled.
    4. If the agency is in substantial compliance with the hospice licensure rules at the time of the on-site survey, a survey report is generated and a license is issued.
    5. If the agency is not in substantial compliance with the hospice licensure rules, the applicant will be informed at the time of the on-site survey what additional information is needed to be in substantial compliance.
    6. If there is a question of safety or adequacy of care, then the section attempts to assist the agency to reach compliance. If those efforts fail, then licensure is denied.
  4. Obtain certification: Acute and Home Care Licensure and Certification Section
    1. Agencies wishing to be certified for Medicare/Medicaid as a hospice agency must contact the section for a certification application packet.
    2. The agency completes all required information and returns it to the section.
    3. If the application packet is approved by the section and by the agency’s fiscal intermediary (CMS Form 855), the agency will notify the section to schedule an on-site survey. As soon as the agency is ready for operation, it must notify the section office in writing to request an on-site survey.
    4. The section conducts the survey. If an agency has deficiencies during the initial survey, the effective date of certification will be the latest date a plan of correction is signed by the agency.