How to start a hospice in New York

New York requires a Certificate of approval to operate a hospice (Public Health Law Article 40) from New York State Department of Health, with establishment approval by the Public Health and Health Planning Council (PHHPC) to operate a hospice.

License required

Yes

License

Certificate of approval to operate a hospice (Public Health Law Article 40)

Issuing agency

New York State Department of Health, with establishment approval by the Public Health and Health Planning Council (PHHPC)

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

N.Y. Public Health Law Article 40 (§ 4004 establishment of hospices)

1. File a Certificate of Need/establishment application with the Public Health and Health Planning Council on prescribed forms
2. PHHPC forwards it to the regional health systems agency (if any) for recommendations
3. PHHPC reviews public need, character and competence of the principals, and financial resources (public hearing possible)
4. With PHHPC written approval, the Commissioner issues the certificate of approval

Program

New York State Medicaid (NYS Department of Health; eMedNY)

Enrollment portal

NYS Medicaid Provider Services Portal (PSP)

Fiscal agent

eMedNY (NYS DOH's Medicaid claims system). Revalidation notices come from ProviderEnrollment@acentra.com. The eMedNY pages we reviewed do not name the claims contractor.

Application fee

Under 42 CFR 455.460, certain provider types and enrollment transactions owe an application fee, and the PSP tells you when one is due. The fee is waived if the provider is enrolled in Medicare or another state's Medicaid/CHIP program, or already paid the fee to Medicare. A hardship waiver can be requested with the application; New York forwards it to CMS. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

High-risk providers undergo a fingerprint-based background check for every owner holding 5% or more. ABA providers, 1915(c) HCBS waiver providers and Licensed Home Care Services Agencies are newly designated high risk. Results of a Medicare screening can count toward fingerprinting.

Site visit

Moderate- and high-risk providers get pre- and post-enrollment site visits. Results of a Medicare screening can count toward the site visit requirement.

Revalidation

Revalidation frequency depends on risk level: high-risk every 3 years, moderate every 4, limited every 5. Since May 2026 all revalidation is done in the PSP; paper processes have ended. Under an April 2026 CMS directive, every provider is being revalidated over 24 months. Phase 1 covers high-risk, DME and providers not revalidated since the COVID-19 emergency began. Phase 2 (early 2027) covers newly high-risk ABA, 1915(c) HCBS and LHCSA providers. The remaining providers follow through June 2028. Wait for an individual notice before revalidating. Missing the deadline ends enrollment.

Full New York Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (CON)

Agency

New York State Department of Health, Division of Planning & Licensure; Public Health and Health Planning Council (PHHPC) acts on establishment and full-review applications

Services covered

• hospitals
• nursing homes
• diagnostic and treatment centers (including ambulatory surgery and dialysis)
• midwifery birth centers
• certified home health agencies
• licensed home care services agencies
• long term home health care programs
• hospice
• establishment / transfers of ownership or control
• construction, renovation and major medical equipment

New York certificate of need details →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

No change on 2027-01-01: an off-ramp condition in the indexing law was met, so rates stay $17.00 (NYC, Long Island, Westchester) and $16.00 (rest of state).

Direct-care wage floor

Home care aide minimum wage: $19.65/hour in New York City, Long Island and Westchester and $18.65 elsewhere (from 2026-01-01), rising on 2027-01-01 to $20.00 and $19.00. Covers home health aides, personal care aides and similar in-home workers.

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)

95 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

39 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

6,380,652 (as of Jun 1, 2026)

All New York Hospice Medicaid rates, ranked →