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Hospice staff compliance

Hospice staff requirements, state by state

Federal rules set the floor for every hospice. Ten states add their own rules for background checks, aide credentials, health screening and training: California, Texas, Florida, Ohio, Pennsylvania, Georgia, Arizona, Illinois, New York and Michigan. Here is what each adds, with the source.

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Requirement types for a hospice: the monthly OIG and SAM exclusion checks beside the quarterly state Medicaid list check, and agency policies such as driver's licenses for staff who drive to visits, flu vaccination and therapist liability insurance, each with who it applies to and how it renews

Built from the federal hospice rules and a state-by-state review of statutes and regulations, October 2026. General information, not legal advice. Rules change; confirm current requirements with your state licensing authority and your accreditor.

The federal floor

What every Medicare hospice tracks, in every state

These come from the hospice Conditions of Participation (42 CFR Part 418) or from federal guidance, and they are the same in all fifty states.

Federal hospice staff requirements. CPR, TB testing and flu vaccination are not federal hospice requirements for home-based staff; states and agency policy set them.
RequirementWho it coversWhenRule
License or certification, kept currentProfessionals furnishing services directly, under contract or under arrangementsCurrent at all times§418.114(a)
Criminal background checkEmployees with direct patient contact or access to patient records; contracts must require contracted entities to check their staffPer state rules; where the state sets none, within 3 months of hire, covering every state lived or worked in during the past 3 years§418.114(d)
Aide training and competency evaluationHospice aidesBefore furnishing services; again after 24 months without paid aide work§418.76(a)-(c)
Aide in-service trainingHospice aidesAt least 12 hours in each 12 months, supervised by an RN§418.76(d)
On-site aide observation by an RNHospice aidesAt least every 12 months§418.76(h)
OrientationHospice philosophy: employees and contracted staff with patient and family contact. Job-specific: every employeeAt the start§418.100(g)(1)-(2)
Competency assessmentEveryone who furnishes care, volunteers includedNo federal interval; your written policy sets it§418.100(g)(3)
Emergency preparedness trainingAll staff, people working under arrangement, and volunteersAt hire, then at least every 2 years§418.113(d)(1)
Infection control educationEmployees and contracted providersNo federal interval; your policy sets it§418.60(c)
CPR certificationOnly staff of a hospice-run inpatient facility covered by its restraint and seclusion trainingWith periodic recertification§418.110(o)
OIG exclusion checkEveryone, contractors and volunteers includedBefore hire, then monthly is recommendedOIG guidance, not a CoP
Ten states

What each state adds on top of the federal floor

"Not confirmed" means our review found no state rule for that item. It does not prove none exists, and your accreditor or your own policy may still require it.

California

Background checks
Certified home health aides carry a CDPH fingerprint clearance, run through the state Department of Justice, before patient contact. The federal check covers everyone else with patient contact or record access.
Aides
Hospice aide services must come from a CDPH-certified home health aide. The certificate runs 2 years, and renewal needs 24 hours of in-service, at least 12 in each year.
TB and health
A health exam around hire with TB screening, then annual TB screening, for physician, nursing and aide staff (state hospice licensing standards). Cal/OSHA requires at least an annual TB assessment for exposed employees (8 CCR §5199).
Also in the file
The emergency hospice regulations in effect since June 22, 2026 require an OIG exclusion clearance before employment, reference checks, a signed confidentiality agreement and all performance evaluations in the personnel record (22 CCR §74884), and 12 hours a year of training for management staff (22 CCR §74880).
Nurse Licensure Compact
Not a member
Sources

Texas

Background checks
A name-based DPS criminal history check plus Nurse Aide Registry and Employee Misconduct Registry searches before hire or first client contact, with both registries searched again every 12 months. No client contact while results are pending (Health and Safety Code ch. 250; 26 TAC §§558.247, 558.855).
Aides
No registry listing required. Training and competency follow the federal path, and an aide requalifies after 24 months without paid aide work (26 TAC §558.843).
TB and health
Not confirmed.
Also in the file
A signed job description, license and reference verification, printouts of the registry searches, annual evaluations of employees and volunteers, and a written drug-testing policy (26 TAC §§558.245, 558.246, 558.253).
Nurse Licensure Compact
Member since January 19, 2018
Sources

Florida

Background checks
Level 2 screening (state and FBI fingerprints) before patient contact for staff giving direct personal care or with access to clients' funds, property or living areas, and for some contractors. Rescreening every 5 years, and a new screen after a break of more than 90 days (Fla. Stat. §§400.6065, 408.809, 435.04, 435.12).
Aides
No state hospice aide credential; the federal path applies. Certified nursing assistants renew every 2 years with 24 hours of in-service (Fla. Stat. §464.203).
TB and health
Not confirmed.
Also in the file
Dementia training: written information at hire, 1 hour within 3 months for staff with direct contact, and 3 more hours within 9 months for direct-care staff (Fla. Stat. §400.6045(1); rule 59A-38.019).
Nurse Licensure Compact
Member since January 19, 2018
Sources

Ohio

Background checks
A BCII fingerprint check, plus an FBI check for anyone not an Ohio resident for the past 5 years, for paid staff giving direct care to people 60 and over. Conditional hire is allowed when the check is requested within 5 business days (ORC §3712.09; OAC 3701-13).
Aides
The "hospice aide" title requires a state training program and good standing on the Ohio Nurse Aide Registry, under a rule effective December 29, 2025 (OAC 3701-19-01).
TB and health
A written communicable-disease and TB screening policy for staff and volunteers with direct contact; no fixed interval (OAC 3701-19-09).
Also in the file
A written job description for every staff member, volunteer and contractor, license verification, and regular performance evaluations (OAC 3701-19-09).
Nurse Licensure Compact
Member since January 1, 2023
Sources

Pennsylvania

Background checks
No hospice-specific state rule confirmed. Ask the Department of Health whether any other state screening law reaches your staff.
Aides
The federal path applies.
TB and health
Not confirmed.
Also in the file
Pennsylvania has no hospice-specific personnel regulations; the Department of Health uses the federal hospice rules as its interim standards.
Nurse Licensure Compact
Member, fully implemented July 7, 2025
Sources

Georgia

Background checks
State (GCIC) and FBI fingerprints with continuous Rap Back monitoring, before placement with a supervised 30-day grace period. Registry checks come first, including the nurse aide registry, the sex offender registry and the OIG exclusion list. Georgia-licensed physicians, nurses, pharmacists and dentists are excluded (rr. 111-8-37-.13, 111-8-12-.04).
Aides
A current CNA, home health aide training at a Medicare-certified agency, or a 75-hour program run by the hospice; 12 hours of continuing education a year; and a yearly RN-observed competency (r. 111-8-37-.18).
TB and health
Initial and annual health screening by a licensed professional for the administrator and for staff and volunteers with patient or family contact (r. 111-8-37-.13).
Also in the file
Current CPR or BLS certification for everyone giving hands-on care to a patient who has no do-not-resuscitate order; yearly training in infection control, abuse and neglect, patient rights and palliative care; yearly skills competency (r. 111-8-37-.13).
Nurse Licensure Compact
Member
Sources

Arizona

Background checks
No state check reaches hospices; the fingerprint clearance card statute (A.R.S. §36-411) names other facility types. The federal check applies.
Aides
No state certification required; the federal path applies.
TB and health
Proof of freedom from infectious TB on or before the start date for staff with direct patient interaction, then a yearly symptom-free statement signed by a medical practitioner instead of a yearly test (A.A.C. R9-10-606, R9-10-113).
Also in the file
Yearly abuse and neglect recognition training, orientation within the first week, and personnel records kept 24 months after separation (A.A.C. R9-10-603, R9-10-606).
Nurse Licensure Compact
Member
Sources

Illinois

Background checks
A Health Care Worker Registry check before hire, then a fingerprint check (state and FBI) after a conditional offer, for unlicensed direct-care workers, contracted and agency staff included. Conditional employment can last up to 3 months (225 ILCS 46).
Aides
Unlicensed aides must be on the Health Care Worker Registry.
TB and health
A health evaluation within 30 days of hire, with a baseline TB test following the CDC approach (77 Ill. Adm. Code 280.2045, 696.140).
Also in the file
Dementia training for staff with direct access to clients with dementia (6 hours within 60 days, then 3 hours a year), and annual in-service with records (77 Ill. Adm. Code 973.140, 280.2040).
Nurse Licensure Compact
Not a member
Sources

New York

Background checks
DCJS and FBI fingerprints for unlicensed staff giving face-to-face care, agency temps included, with temporary approval and observation while results are pending. Licensed professionals and volunteers are excluded (10 NYCRR Part 402).
Aides
Approved aide training or an exam, a Home Care Registry check before the aide starts, and 12 in-service hours a year (18 for advanced aides) (10 NYCRR Part 403, 794.3).
TB and health
Before hire, a TB risk assessment, symptom check and TB test, then annual assessments with tests only as indicated; a health assessment before patient contact and yearly; measles and rubella immunity; a flu vaccine or a mask during flu season (10 NYCRR 794.3, 2.59).
Also in the file
Prior employment or references checked before patient contact, and an annual performance and competency review, volunteers included (10 NYCRR 794.3).
Nurse Licensure Compact
Not a member
Sources

Michigan

Background checks
State police and FBI fingerprints plus abuse and neglect registry checks before employment, for employees and contractors with regular direct access, with continuous notice of new arrests (MCL 333.20173a).
Aides
The federal path applies, and the annual RN on-site observation is filed in the aide's personnel file (R 325.45365). Nurse aide certificates renew every 24 months; from March 23, 2026, renewal also needs 12 hours a year of continuing education (R 400.315).
TB and health
Communicable-disease and TB screening at hire following the CDC baseline approach, with immunization status checked (R 325.45139).
Also in the file
Infection-control training at hire and ongoing for staff, contractors and volunteers (R 325.45141).
Nurse Licensure Compact
Not a member
Sources
Tracking your state's rules

Add what your state requires, the way it renews

Hospice accounts are offered the federal requirements with their citations. Anything your state adds becomes a requirement of its own.

Its own renewal rule

A Texas registry search that repeats every 12 months, a Florida rescreen every 5 years, or a Georgia health screening every year.

The roles it covers

Apply a requirement to the roles your state names, such as unlicensed direct-care staff, and everyone else shows it as exempt.

The proof beside it

Attach the clearance letter, registry printout or health screening form to the requirement it proves.

FAQ

Questions about state rules

Is CPR certification required for hospice staff?

Federally, only in one case: staff of a hospice-run inpatient facility who are covered by its restraint and seclusion training must be certified in CPR, with periodic recertification (42 CFR §418.110(o)). Of the ten states here, Georgia adds a rule: everyone giving hands-on care to a patient who has no do-not-resuscitate order needs current CPR or BLS certification. Elsewhere it is agency policy.

How soon after hire must a hospice background check be done?

Under 42 CFR §418.114(d), checks follow your state's requirements. Where the state sets none, the check must be obtained within three months of the date of employment and cover every state the person lived or worked in during the past three years. Several states move it earlier: Florida and Texas, for example, allow no patient contact until results are back.

Do hospice staff need an annual TB test?

There is no federal hospice TB rule, and CDC does not recommend annual TB testing of health care personnel without a known exposure or ongoing transmission. Some states set their own rules. Of the ten here, California requires annual TB screening for physician, nursing and aide staff, New York requires an annual TB assessment, and Arizona requires a yearly symptom-free statement.

Which of these states are in the Nurse Licensure Compact?

Texas, Florida, Ohio, Pennsylvania, Georgia and Arizona are members. California, Illinois, New York and Michigan are not. Record whether each nurse's license is single-state or multistate along with its number and expiration date.

Why only ten states?

We list a state only after checking its rules against the official text or a faithful copy of it, and we leave out anything we could not confirm. States are added once they have been verified.

Does Personnel Ledger know my state's rules?

Hospice accounts are offered the federal requirements with their citations. You add what your state requires as requirements of your own, each with the roles it applies to and its renewal rule, and this page shows what to add for ten states.

This page is general information, not legal advice. It summarizes federal regulation and a review of state statutes and regulations made in October 2026. State rules change, and some apply only to certain staff or facility types. Confirm your obligations with your state licensing authority and your accreditor.

Related guides

Hospice background checks The federal three-month rule and the states that move it earlier. TB and health screening What the CDC recommends and which states require more. CPR certification tracking Where CPR is required for hospice staff, and where it is policy.

See all hospice staff file guides

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