How to start a hospice in Louisiana

Louisiana requires a Hospice license (home-based hospice, with optional inpatient hospice facility and branches) from Louisiana Department of Health, Health Standards Section (HSS) to operate a hospice. Fee: Fees are set by LDH; listed on the HSS page: branch $300 (non-refundable); change of location $600 for the parent plus $300 per alternative delivery site; name change $25; Facility Need Review application $200 (non-refundable).

License required

Yes

License

Hospice license (home-based hospice, with optional inpatient hospice facility and branches)

Issuing agency

Louisiana Department of Health, Health Standards Section (HSS)

Fee

Fees are set by LDH; listed on the HSS page: branch $300 (non-refundable); change of location $600 for the parent plus $300 per alternative delivery site; name change $25; Facility Need Review application $200 (non-refundable).

Insurance and bonds

$75,000 line of credit from a federally insured lender; general and professional liability insurance of at least $300,000; workers' compensation (LDH named as certificate holder for CHOW).

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

LAC 48:I, Chapter 82 (Minimum Standards for Hospice Licensing); Facility Need Review rules

1. Obtain Facility Need Review (FNR) approval (HSS FNR application, $200 fee) before applying for an initial license
2. E-mail a Letter of Intent to HSS
3. Submit the license application with required documents
4. Pass the licensing survey
5. Notify HSS of name/address changes within 24 hours; new FNR is needed for a change of ownership

Staffing

• Administrator
• Director of Nursing
• Medical Director

Program

Louisiana Medicaid (Louisiana Department of Health) — Healthy Louisiana

Enrollment portal

Louisiana Medicaid Provider Enrollment Portal (via www.lamedicaid.com)

Fiscal agent

Gainwell Technologies (Louisiana Medicaid fiscal intermediary; runs provider enrollment and screening)

Application fee

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

Louisiana applies fingerprint-based criminal background checks by risk level at enrollment and at every revalidation. 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

Louisiana applies site visits by risk level at enrollment and at every 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

Louisiana revalidates all providers, including ordering/referring providers, at least every five years, and DMEPOS providers every three years. Notices go out by email and letter; there are no exemptions or extensions, and missing the due date means denied claims and deactivation, requiring a full new application. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Louisiana Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Facility Need Review (FNR)

Agency

Louisiana Department of Health, Health Standards Section (FNR program)

Services covered

• nursing facilities and nursing facility beds (licensed and Medicaid-certified)
• HCBS providers: personal care attendant, supervised independent living, monitored in-home caregiving and respite
• hospice providers and inpatient hospice facilities
• pediatric day health care facilities
• behavioral health providers offering psychosocial rehabilitation (PSR) and/or community psychiatric support and treatment (CPST)
• residential substance abuse treatment
• opioid treatment program clinics
• ICF/IID

Moratoria

A statutory moratorium (R.S. 40:2116.1(B)) bars new FNR approvals for nursing facilities or additional nursing facility beds until it expires; the rules separately allow relocation, conversion and abeyance of existing beds.

Louisiana 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.

Direct-care wage floor

OCDD waivers (New Opportunities, Children's Choice, Supports, Residential Options): since 2021-10-01 direct support workers must be paid at least $9.00/hour, alongside a $2.50/hour rate increase.

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)

422 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

118 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,264,327 (as of Jun 1, 2026)

All Louisiana Hospice Medicaid rates, ranked →