When a hospice resident's care needs exceed what an RCFE is normally licensed to provide, California law requires a formal written waiver request to CDSS before the resident can remain in your facility. This document covers all required elements.
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An RCFE is licensed to provide non-medical residential care. When a resident enrolls in hospice, their care needs may exceed what an RCFE is normally permitted to provide. A hospice waiver is a formal request to CDSS to allow the resident to remain in the RCFE and receive hospice services on-site, rather than transferring to a skilled nursing facility.
Health and Safety Code §1569.73 authorizes CDSS to grant waivers allowing RCFE residents to receive hospice care exceeding the standard scope of care. CCR §87633 sets out the requirements for how RCFEs must coordinate with hospice agencies and document the arrangement.
The hospice agency must provide a written plan of care, supply the clinical staff who provide skilled nursing and aide services, coordinate with the resident's physician, and work with the RCFE administrator to ensure the facility can safely support the resident's remaining needs. The RCFE provides room, board, personal care, and supervision. The hospice provides the clinical services.
Yes. CDSS reviews the request and may deny it if the resident's care needs cannot safely be met in a residential (non-skilled-nursing) setting, if the hospice agency cannot provide adequate clinical coverage, or if the RCFE does not have staff trained for the required care tasks. Incomplete documentation is a common reason for delays.
If CDSS does not approve the waiver and the resident's needs exceed the RCFE's licensed scope, the facility is required to initiate a discharge to an appropriate level of care. Retaining a resident with unmet needs beyond the RCFE's scope without an approved waiver is a licensing violation. This is why submitting a complete request as early as possible is critical.