Your Hospice Leader Can Only Run One Hospice. Can They Also Run a Home Health Agency?

A guest at one of our recent webinars asked one of the sharpest questions we’ve heard about California’s new hospice rulebook. Everyone now knows that CDPH’s emergency regulations — Title 22 CCR sections 74800–74908 — tie your Administrator, Director of Patient Care Services (DPCS), and Medical Director to a single hospice. The guest went one level deeper: “Can that same person also be connected to a home health agency at the same time?”

It’s a great question, because so many operators run a hospice and a home health agency side by side and share leadership across both. We went straight to the regulatory text to answer it. The short answer: yes — the “one hospice” limit does not stop that person from also serving a home health agency. But “allowed” is not the same as “invisible,” and there are three reasons to be careful even though the door is open. Here is exactly what the rule says, and where the real exposure is.

What the Rule Actually Restricts

The key move is to read the concurrent-employment language literally. In all three leadership sections, the restriction names other hospices — and nothing else. Here is the exact text for each role:

Administrator — § 74876(f)

“An Administrator or an Administrator Designee must not have concurrent employment with another hospice.”

Director of Patient Care Services — § 74852(e)

“A Director of Patient Care Services or a Director of Patient Care Services Designee must not have concurrent employment with another hospice.”

Medical Director — § 74856(f)

“A Medical Director or a Medical Director Designee must not have concurrent employment with other hospices.”

In every case, the object of the sentence is another hospice. A home health agency is a separate license type — and it is simply not named. There is no companion provision anywhere in sections 74800–74908 that bars a hospice Administrator, DPCS, or Medical Director from also serving a home health agency. So on the plain text, the same individual may hold the top role at your hospice and a leadership role at a home health agency at the same time.

This Wasn’t an Oversight — CDPH Clearly Had Home Health in Mind

You might wonder whether the drafters just forgot about home health. They didn’t. Home health is written into these same sections — just in the qualifications, not the restrictions. To even qualify for these roles, home-health experience counts:

• The Administrator (§ 74876(b)) qualifies on supervisory experience “in a hospice, home health agency, primary care clinic, or health facility.”
• The DPCS (§ 74852(b)) qualifies on supervisory experience “in a hospice or a home health agency.”
• The Medical Director (§ 74856(b)) qualifies on experience “in a hospice, home health agency, or providing palliative care.”

In other words, CDPH had home health directly in view when it wrote these roles — it treated home-health leadership as valuable, qualifying background — and it still chose to draw the concurrent-employment fence hospice-to-hospice only. That’s a deliberate line, not a gap. The concern these regulations were built to solve was the “27 hospices, one administrator” shell pattern the State Auditor found — a hospice-stacking problem, which is exactly what the wording targets.

The Rural Exceptions (and What They Don’t Touch)

The only loosening of the “one hospice” rule is a narrow rural carve-out — and it only ever adds more hospices, never anything else:

• Administrator / DPCS: may be concurrently employed by no more than two hospices, only if both are in the same rural area (§ 74876(g), § 74852(f)).
• Medical Director: may be concurrently employed or contracted by no more than three hospices, only if all are in the same rural area (§ 74856(g)).

These exceptions are about stacking hospices in a low-population county. They have nothing to do with home health, and you don’t need them to justify a shared hospice/home-health leader — that’s already permitted outside any rural exception.

Allowed Is Not the Same as Unwatched: Three Things to Get Right

Here is the important part for a compliance-minded operator. The fact that the rule permits a shared hospice/home-health leader does not mean it goes unnoticed. Three separate things still apply.

1. CDPH actively cross-references operators tied to multiple licensed entities

CDPH’s own Hospice and Home Health Program Integrity fact sheet states that, as part of licensing review, the Department “conducts system reviews across agencies to identify operators connected to multiple CDPH licensed entities, verify employment records, and evaluate compliance…at their existing agencies.” A person leading both a hospice and a home health agency will show up in that review. That’s not a violation — but it does mean the arrangement should be clean, documented, and consistent with what you’ve reported on each agency’s application.

2. The person still has to actually do the hospice job

Permission to hold two roles doesn’t suspend the duties of either. Your Administrator “must be on the premises of the hospice or accessible by telecommunication during their scheduled work hours” (§ 74876(d)), and the DPCS and Medical Director each carry real, ongoing responsibilities. A leader spread thin across a hospice and a home health agency is legal — but if the hospice role goes uncovered in practice, a surveyor cites the failure to perform the role, regardless of what else the person is running. Make sure the coverage is genuine, not just on paper.

3. The federal affiliations rule is a separate gate

California licensure is only one layer. On the Medicare side, the 2019 affiliations rule (42 CFR 424.535(a)(19)) lets CMS revoke a hospice’s enrollment over an affiliation it deems an “undue risk” — and someone with managerial control at both a hospice and a home health agency is an affiliation. If the home health agency has a troubled history, an arrangement California permits can still become a federal problem. We’ve written about a hospice that lost its Medicare enrollment over exactly this kind of affiliation — worth reading before you formalize a shared-leadership structure.

One More Distinction: Employment vs. Ownership

Notice that the Title 22 provisions restrict concurrent employment in the role — Administrator, DPCS, Medical Director. That’s a question about who manages the agency. Shared ownership across a hospice and a home health agency is a distinct issue, disclosed and reviewed through the licensing and change-of-ownership process, not through these concurrent-employment sections. Both a shared manager and a shared owner are perfectly visible to CDPH; they’re just governed by different parts of the framework. If your question is really about common ownership, that’s a separate analysis — and one worth doing deliberately given the current enforcement climate.

The Bottom Line

To answer the webinar guest directly: yes — under California’s new hospice regulations, your Administrator, DPCS, or Medical Director can serve one hospice and also be connected to a home health agency at the same time. The “one hospice” limit is written hospice-to-hospice and doesn’t reach across to home health — deliberately so. What it doesn’t give you is a pass on the substance: CDPH cross-references shared operators, each role’s duties still have to be genuinely met, and the federal affiliations rule sits on top of everything. Structure it cleanly, document it, and it’s a legitimate and common way to run care-at-home services under one roof.