How to start a hospice in Ohio

Ohio requires a Hospice care program license (3-year) from Ohio Department of Health to operate a hospice. Fee: License and renewal fees are set by Director of Health rule and by statute may not exceed $600 each (covering the 3-year license), except as allowed in ORC 3712.03(B); a separate inspection fee is also set by rule.

License required

Yes

License

Hospice care program license (3-year)

Issuing agency

Ohio Department of Health

Fee

License and renewal fees are set by Director of Health rule and by statute may not exceed $600 each (covering the 3-year license), except as allowed in ORC 3712.03(B); a separate inspection fee is also set by rule.

Renewal

Every 3 years · Renewal fee capped at $600 per 3-year term (subject to ORC 3712.03(B)); apply at least 90 days before expiration. In-home programs must show compliance with ORC 3712.062 at renewal.

Medicare oversight

CMS places hospices in this state that newly enroll in Medicare, reactivate, or change ownership into a Provisional Period of Enhanced Oversight (medical review such as prepayment review). It began 2025-12-30 for Ohio.

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

Ohio Rev. Code §§ 3712.03, 3712.04; Ohio Adm. Code ch. 3712-1

1. Apply to ODH on department forms with required information and the rule-set license fee
2. ODH grants the license if the program complies with ORC chapter 3712 and rules
3. Renew every 3 years, filing at least 90 days before expiration

Program

Ohio Medicaid (Ohio Department of Medicaid, ODM)

Enrollment portal

Provider Network Management (PNM) module of the Ohio Medicaid Enterprise System (OMES)

Application fee

Organizational provider types pay a non-refundable fee of $750 per application in 2026 (42 CFR 455.460 and OAC 5160-1-17.8), paid online in PNM. Individual practitioners and practitioner groups do not pay it. The fee is waived if paid to Medicare or another state's Medicaid program within the past five years for new enrollments; ODM's revalidation FAQ uses a two-year window for revalidations. The application cannot be finished until the fee is paid or proof is uploaded.

Fingerprinting

ODM requires BCI&I criminal record checks for certain providers, notably Ohio Home Care Waiver non-agency providers, who have done annual checks. ODM is moving these providers to RAPBACK, the retained-applicant fingerprint database, which gives continuous criminal-history updates at no cost to the provider. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under OAC 5160-1-17.8, some providers get pre- and post-enrollment on-site screening visits. Public Consulting Group (PCG) does the visits for providers not already screened by another state or federal agency. The visits are unannounced, and not cooperating can affect enrollment. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

ODM revalidates under 42 CFR 455.414 (at least every 5 years). It sends a notice about 120 days before the deadline, one per provider number, and also posts it in PNM correspondence. Do not start revalidation until the notice arrives. Revalidating with Medicare does not replace Ohio revalidation. ODM may do an on-site visit as part of it.

Full Ohio Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (long-term care)

Agency

Ohio Department of Health (Director of Health)

Services covered

• long-term care facilities: licensed nursing homes and skilled nursing / long-term care beds (including county homes and hospital-registered long-term care beds)
• new long-term care facilities, increases in bed capacity, and relocation of beds between sites

Ohio certificate of need details →

State minimum wage

$11.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $11.40 on 2027-01-01 ($5.70 tipped) for employers above the gross-receipts threshold.

Rate pass-through

HB 33 (FY2024-25 budget) requires DODD waiver provider rate increases to be used to raise wages and workforce supports; the bill's specific $17/$18 per hour rate language was vetoed, but the funding remained.

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)

420 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

169 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,597,852 (as of Jun 1, 2026)