How to start a hospice in South Carolina

South Carolina requires a Hospice program (outpatient) license; hospice facility (inpatient) license from South Carolina Department of Public Health (DPH), Healthcare Quality — Healthcare Facility Licensing to operate a hospice. Fee: Initial and renewal license fee $100 plus $50 per county served; hospice facilities add $10 per bed or $75, whichever is greater. Payable by check, card or money order; refunded if the application is denied.

License required

Yes

License

Hospice program (outpatient) license; hospice facility (inpatient) license

Issuing agency

South Carolina Department of Public Health (DPH), Healthcare Quality — Healthcare Facility Licensing

Fee

Initial and renewal license fee $100 plus $50 per county served; hospice facilities add $10 per bed or $75, whichever is greater. Payable by check, card or money order; refunded if the application is denied.

Renewal

Same as initial ($100 + $50/county; facility bed fee). Late renewal: 25% of the license fee, minimum $75.

Certificate of need

Not 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

S.C. Code § 44-71-10 et seq. (Hospice Licensure Act); S.C. Code Regs. 60-78 (Standards for Licensing Hospices)

1. Submit the Application for Licensure — Hospice Program (or Hospice Facility) with the fee
2. Attach Secretary of State documentation, officer list, 5%+ owner list and any lien/claim holders
3. For a new inpatient hospice facility or added beds: obtain a DPH Certificate of Need first
4. Pass DPH review/inspection and receive the license (not transferable)
5. Renew with application and fee before expiration

Program

Healthy Connections Medicaid (South Carolina Department of Health and Human Services, SCDHHS)

Enrollment portal

SCDHHS online Provider Enrollment web application

Application fee

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. SCDHHS's enrollment page does not list a separate state fee.

Fingerprinting

High-risk providers must submit fingerprints and/or have a physical site visit. If fingerprinting runs past the 30-day revalidation deadline, sending a copy of the fingerprint appointment confirmation with the other documents prevents termination. 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

SCDHHS screening includes site visits where applicable, and high-risk providers may get a physical site visit at revalidation. 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

Since June 1, 2026, high-risk providers (federal or state-designated) revalidate every year and all others every three years, more often than the federal minimum. Under a CMS-approved two-year strategy, everyone first enrolled before June 1, 2025 will be revalidated. A rapid cohort covers opioid treatment programs, DME, home health, hospice, nursing facilities, private RBHS, independent licensed behavioral health practitioners, BCBAs/BCaBAs and HCBS providers. Wait for a notification letter with a revalidation number, then submit online within 30 days. Missing the deadline counts as voluntary termination.

Full South Carolina Medicaid enrollment guide →

For this business

Not required (licensing source)

CON program

Yes

Program

Certificate of Need (State Certification of Need and Health Facility Licensure Act)

Agency

South Carolina Department of Public Health, Certificate of Need Program

Services covered

• nursing homes: new facilities, bed additions or licensure reclassification, and capital expenditures above the regulatory threshold
• hospitals: construction or establishment of a new hospital, and bed additions or reclassification (only until January 1, 2027)

South Carolina 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)

256 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

88 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

958,052 (as of Jun 1, 2026)

All South Carolina Hospice Medicaid rates, ranked →