Hospice background checks on time and covering every state
Federal rules require a criminal background check for hospice employees with direct patient contact or access to patient records. Personnel Ledger keeps the date it was obtained, the result and the states it covered in each person's file, and shows who is still due.
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Built from the federal hospice personnel rule, CMS surveyor guidance, CMS survey reports and state law in ten states. General information, not legal advice. Confirm your specifics with your state and your accreditor.
Who needs a check, when it is due, and which states it covers
Every hospice employee with direct patient contact or access to patient records. That reaches office staff who can open the patient record, not only clinicians.
42 CFR §418.114(d)(1)On the timing your state law sets. Where your state sets none, within three months of the date of employment.
42 CFR §418.114(d)(2)Where your state sets no rule of its own, the check covers every state the person lived or worked in during the past three years.
42 CFR §418.114(d)(2)Contracted staff are covered through the contract: hospice contracts must require every contracted entity to obtain criminal background checks on its employees who have direct patient contact or access to patient records (42 CFR §418.114(d)(1)). Per-diem staff paid as employees, and volunteers under the hospice's jurisdiction, count as employees under the hospice rules (42 CFR §418.3), so the same check applies to them.
CMS surveyor guidance has surveyors confirm that each check was completed within three months of employment for every state the person lived or worked in during the prior three years. A check that covered only the current state does not show that.
One of the three staff-file findings cited most
By our count of CMS survey reports, 159 of the 2,031 hospice standard surveys in 2025 that found any deficiency cited at least one background check tag (L0795 or L0796), down from 188 in 2024.
Source: our count of CMS QCOR hospice survey reports (Form CMS-2567), CY2024 and CY2025 standard surveys with at least one finding, state agencies and accreditors combined. A survey can cite both tags.
A return treated as a continuation
A volunteer came back after a two-year leave and no new check was run. Treating a long break as a new hire is the safer habit.
Late against the state rule
A check finished after the person's first patient contact, where the state and the hospice's own policy required it before.
State rules quoted back
Surveyors in Iowa and Virginia quoted their own state's check and timing rules in their findings, not only the federal one.
Contracts without the clause
Therapy and medical equipment contracts that did not require the contractor to run checks, or did not say who would.
How ten states change the timing
The federal three-month window applies only where a state sets no rule. In the ten states we researched, most set one.
| State | What it adds |
|---|---|
| Florida | Level 2 fingerprint screening before patient contact, a rescreen every 5 years, and a new screening after a break of more than 90 days. |
| Georgia | State and FBI fingerprints before placement, with a supervised 30-day grace period, and continuous monitoring after that. |
| Michigan | State police and FBI fingerprints plus abuse and neglect registry checks before employment, with a conditional hire allowed on a signed disclosure, and continuous notice of new arrests. |
| Illinois | A Health Care Worker Registry check before hire and fingerprints after a conditional offer, for unlicensed direct-care workers. |
| New York | Fingerprints within 10 business days for unlicensed direct-care staff, with observed temporary approval while results are pending. |
| Ohio | A fingerprint check requested within 5 business days for paid direct care of adults 60 and older, with release if results are not back in 30 days. |
| Texas | No client contact while results are pending, and, for unlicensed staff and volunteers, two state registries searched before contact and again every 12 months. |
| Pennsylvania | A state police report under the Older Adults Protective Services Act, with a provisional hire period. Whether it covers hospices is not confirmed. |
| California and Arizona | No state check found for most hospice staff, so the federal rule applies. California certified home health aides carry their own fingerprint clearance. |
Each state's rule, with its sources, is on hospice staff requirements by state. Several state programs leave out licensed professionals or volunteers; the federal check under 42 CFR §418.114(d) still applies to them.
A dated check for everyone in scope
Due from the hire date
Set the check to come due a set number of days after hire, so a new hire is due from day one. If your state wants it sooner, set a shorter window.
The states it covered
Record the date requested, the date obtained, the result and the states the check covered, so the file shows more than "done".
Only who needs one
Apply it to the roles with patient contact or record access. Anyone else shows as exempt, with the reason written down.
No report to store
You do not need to upload the report itself. The file holds the result and the dates, and attaching a document stays your choice.
Scheduled re-checks
If your state re-screens on a cycle, give the requirement a repeat interval and it comes due again on its own.
Hospice background checks, answered
Do hospice office staff need a background check?
They do if they have access to patient records. The federal rule covers hospice employees with direct patient contact or access to patient records (42 CFR §418.114(d)(1)), so intake, billing and scheduling staff who can open the patient record are in scope.
Which states does a hospice background check have to cover?
Where your state sets no rule of its own, every state the person lived or worked in during the past three years (42 CFR §418.114(d)(2)). Where your state does set a rule, follow the state's timing and type of check.
How are contracted staff covered for background checks?
Through the contract. Hospice contracts must require the contracted entity to obtain criminal background checks on its employees who have direct patient contact or access to patient records (42 CFR §418.114(d)(1)). Keep the signed contract with that clause, and note in each contracted person's file how their check is covered. See contracted staff files.
Do hospice volunteers need background checks?
Under the hospice rules a volunteer under the hospice's jurisdiction counts as an employee (42 CFR §418.3), so volunteers with patient contact or record access need one too. Volunteer Ledger, our sister product, keeps volunteer files.
Does a returning employee need a new background check?
The federal rule does not say. A 2025 finding cited a volunteer who returned after a two-year leave with no new check, and Florida requires a new screening after a break of more than 90 days, so treating a long break as a new hire is the safer habit.
Can Personnel Ledger order background checks?
No. You run each check with your screening vendor or your state, and Personnel Ledger records the dates, the result and the states it covered, so the evidence is in the file when a surveyor asks for it.
This page is general information, not legal advice. Background check rules come from federal regulation, your state's law and your accreditor, and they change. Confirm your state's rule with your state licensing authority; see hospice staff requirements by state.
Know every check is on time and covers every state
Personnel Ledger keeps each background check's dates, result and states covered in the person's file. Start a free 45-day trial and add your staff today.