Hospice Waiver: Authorization for

Understanding California's Oversight & Regulation

To retain a terminally ill resident, and permit her to receive care from a hospice agency, an RCFE must obtain a hospice waiver from Community Care Licensing (CCLD).

A hospice waiver, according to Title 22 (§87632), allows for variance with regard to a specific regulation based on a facility-wide need or circumstance which is not typically tied to a specific resident and which would otherwise not be allowed in an RCFE setting. 

When a facility requests a hospice waiver it is requesting permission to accept any resident at any time in the future who may require hospice services.  And since many services provided under hospice care go beyond the scope of practice for unlicensed professionals, the facility will require the assistance of a state and Medicare-certified hospice agency to provide this higher level of care.

Requests for hospice waivers are made to CCLD, in advance, by the facility.  The facility must submit a written request that includes, but is not limited to, the following:

(1) Specification of the maximum number of terminally ill residents the facility wants to have at any one time.

(2) A statement by the Licensee that he has read the section in Title 22 pertaining to hospice care.

(3) A statement by the facility that the terms and conditions of all hospice care plans which are designated as the responsibility of the facility, or under the control of the facility, shall be adhered to by the facility.  This is basically a promise by the facility to follow all the rules.  For a narrative on "all the rules" : Providing Hospice Care.

Per Title 22, CCLD can deny a waiver request if the facility is not in substantial compliance.  Waiver requests will not be approved unless the facility demonstrates the ability to meet the care and supervision needs of terminally ill residents and states a willingness to provide additional staff if required by the hospice plan. 

CCLD is required to respond to a hospice waiver request within 30 days of receipt, either to notify the facility the request has been received, that the request is deficient, and/or that the request has been approved or denied.

When hospice services are required by a resident, Consumers should be aware that:

(1) A Licensee is only required to read the Title 22, § 87633, pertaining to hospice care.  They are not required to have any other mastery of the requirements.  When granting a hospice waiver, CCLD does take into consideration the facility's history of compliance.  It is imperative that consumers review a facility's evaluations and complaints (LIC 809s & LIC 9099s) to evaluate for themselves the ability of a facility to continue to provide quality care when a resident is receiving hospice care.

(2) Title 22 (for RCFEs) contains no staffing requirements or resident-to-staff ratios for RCFEs.  The regulations require only "sufficient staff" as determined by the facility and, at times, CCLD. 

(3) When interviewing potential facilities, inquire about the facility's ability to care for hospice residents (experience, staffing levels, etc).  While the resident may not require such services upon admission, he may need them in the future:  moving at a later date, to a better-equipped facility, may not be a viable option. 


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