How to start a hospice in Alabama

Alabama requires a Hospice license (regular or probational) from Alabama Department of Public Health (State Board of Health), Bureau of Health Provider Standards to operate a hospice. Fee: Application must include the statutory fee under Code of Ala. 1975 §22-21-24; fees are non-refundable and paid to ADPH. The hospice rule does not print a hospice-specific dollar amount.

License required

Yes

License

Hospice license (regular or probational)

Issuing agency

Alabama Department of Public Health (State Board of Health), Bureau of Health Provider Standards

Fee

Application must include the statutory fee under Code of Ala. 1975 §22-21-24; fees are non-refundable and paid to ADPH. The hospice rule does not print a hospice-specific dollar amount.

Renewal

Every year · Licenses run for the calendar year and expire December 31 unless renewed; renewal requires application and fee as for the original license.

Survey and inspection

ADPH surveys hospices; refusing a survey triggers license revocation proceedings and deficiencies need a plan of correction within 60 days.

Certificate of need

Required

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Ala. Admin. Code ch. 420-5-17 (hospice licensure); Ala. Admin. Code r. 410-2-3-.10 (in-home hospice need methodology); Code of Ala. 1975 §§22-21-20 et seq.

1. Obtain a Certificate of Need from SHPDA for each parent hospice (in-home hospice need methodology)
2. Submit the Board's hospice license application form with the statutory fee
3. Pass ADPH survey showing substantial compliance with the hospice rules
4. Receive regular license (or probational license if not fully compliant)

Staffing

• Physician medical director
• Each shift staffed by a registered nurse; RN supervision of nursing and aide services
• Interdisciplinary group including physician, RN, social worker and chaplain/counselor

Program

Alabama Medicaid

Enrollment portal

Alabama Medicaid Electronic Provider Enrollment Application Portal (AMMIS)

Fiscal agent

Gainwell Technologies (runs the Provider Enrollment Unit for the Alabama Medicaid Agency)

Application fee

Alabama collects the fee from new and re-enrolling institutional provider types on its fee list (e.g., ASCs, community mental health centers, DMEPOS suppliers, ESRD clinics, FQHCs), paid by certified or cashier's check to the Alabama Medicaid Agency; the agency's participation requirements document carries the current amount. Hardship exceptions can be requested through the fiscal agent. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Alabama says skilled nursing facilities were moved to the high/moderate risk tier at CMS's direction, and high-risk enrollment triggers a fingerprint-based criminal background check. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Alabama states SNFs get a site visit at initial enrollment and at each 5-year revalidation. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Alabama notifies providers when they are due and posts monthly lists of providers due for revalidation; a file closed for missing revalidation requires a brand-new application. Revalidations can be uploaded through the secure web portal. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alabama Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Alabama State Health Planning and Development Agency (SHPDA); applications decided by the Certificate of Need Review Board

Services covered

• hospitals (general, specialized, psychiatric, long-term care)
• skilled nursing facilities
• intermediate care facilities
• rehabilitation centers
• ambulatory surgery facilities
• kidney disease treatment / freestanding dialysis
• community mental health centers
• alcohol and drug abuse facilities
• facilities for the developmentally disabled
• hospice
• home health agencies
• health maintenance organizations

Alabama certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

260 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

85 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

930,919 (as of Jun 1, 2026)

All Alabama Hospice Medicaid rates, ranked →