Licensing and Certification: Hospice

Have a question about Hospice licensing and certification? Check out our Frequently Asked Questions About Hospice.

These forms are intended to be downloaded and completed by individuals and organizations seeking to be licensed as a hospice program. Use the forms below to apply for an initial license, or to renew your current license. Please read and understand all applicable documents, statutes, and rules listed below before applying for this license.

• Application for a License to Operate a Hospice Program (PDF): Use this form to apply for an initial license, or to submit a change of ownership of your license.
• Renewal Application for a License to Operate a Hospice Provider (PDF): Use this form to renew your current license.
• A Guide to Hospice Care Services (PDF)
• Background Studies for New Owners (PDF)

144A.75 | 144A.751 | 144A.752 | 144A.753 | 144A.754 | 144A.755

Minnesota Administrative Rules: Chapter 4664, Hospice Services

• Hospice Bill of Rights - Regular Print (PDF)
• Hospice Bill of Rights - Large Print (PDF)

• Combined Minnesota & Federal Hospice Bill of Rights - Regular Print (PDF)
• Combined Minnesota & Federal Hospice Bill of Rights - Large Print (PDF)

These websites provide information about the quality of care at hospice services providers and are intended for consumers who want to learn more about the services offered at each provider.

• Hospice Compare Website (cms.gov)
• Hospice Star Ratings (CAHPS) Survey Results

• Health Care Provider Evaluation and Investigation Results
• Verify a Facility License or Professional Credential
• File a Complaint against a Facility or Professional

• Minnesota Network of Hospice and Palliative Care
• National Hospice and Palliative Care Organization

• Medicare State Operations Manual Chapter 2: The Certification Process (PDF)
• CMS - Survey & Certification - General Information
• Medicare State Operations Manual Appendix M: Guidance to Surveyors: Hospice (PDF)
• Entrance Conference (Federal Evaluation: Hospice) (PDF): Sample form describing the entrance conference portion of an MDH survey of a hospice facility.

• Regional Health Care Preparedness Coordinators (RHPCs)
• Bed Rail Safety for Health Care Providers