Questions people ask
What is the 36 month rule for hospice?
The 36 month rule is a Medicare rule about hospice owners, not about patients. If a hospice has a change in majority ownership within 36 months of its first Medicare enrollment or its last change of majority ownership, the new owner generally must enroll with Medicare as a new provider and be surveyed again. It does not limit how long a person can receive hospice care.
Reviewed by our medical director, October 12, 2026
On this page (5 sections)
Where the rule comes from
The rule is in 42 CFR 424.550(b), under the title "prohibitions on the sale or transfer of billing privileges". When a hospice has a change in majority ownership within 36 months of its initial Medicare enrollment, or of its last change in majority ownership, the buyer cannot simply take over the seller's Medicare billing. The hospice generally has to enroll again as a new provider, with a new survey. The regulation lists limited exceptions.
State and federal agencies have found hospice fraud in California, much of it in Los Angeles County, and California has paused new hospice licenses while it tightens oversight. The 36 month rule makes it harder to buy a newly certified hospice and sell it on.
Hospice rules with numbers in them, and who each one applies to
| The number | What it means | Who it applies to |
|---|---|---|
| 36 months | A majority ownership change within 36 months generally means re-enrolling with Medicare as a new provider | Hospice owners |
| Six months | A doctor certifies that life expectancy is six months or less if the illness runs its usual course | The person starting hospice. See the two conditions |
| 90 days, then 60 days | Two 90-day benefit periods, then unlimited 60-day periods, each with a new certification | The person on hospice. See how long Medicare pays |
| 5 days | Inpatient respite care to rest the caregiver, up to 5 days at a time | The family caregiver. See levels of care |
| 20 percent | A hospice's inpatient days may not exceed 20 percent of its total Medicare patient days in a year | The hospice provider. See the 80/20 rule |
What this means for your family
- Nothing in this rule limits how long someone can be on hospice. That depends on the doctor's certification.
- Medicare Care Compare shows a hospice's ownership type and certification date. A recent sale or a new certification is not a bad sign by itself.
- If a hospice you use is sold, your rights do not change. Choosing hospice is your decision. You can stop hospice at any time and return to regular Medicare coverage. You have the right to choose your hospice.
Related questions
Does the 36 month rule limit how long I can be on hospice?
No. It is about who owns the hospice. Hospice continues in benefit periods as long as a doctor continues to certify that the person is eligible.
What happens to patients when a hospice changes owners?
You keep the right to choose. Under Medicare you can change your hospice once in each benefit period. See switching hospice providers.
How do I check who owns a hospice?
Look it up on Medicare Care Compare, which shows the ownership type and certification date, and find the state license in CDPH Cal Health Find. See how to verify a hospice.
Read more
The fuller pages: how to verify a hospice in California and how to choose a hospice.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- October 12, 2026
- Next review
- April 12, 2027
How we write and review this site
Sources
- 42 CFR 424.550: Prohibitions on the sale or transfer of billing privileges, the 36 month rule (opens in a new tab)
- CDPH All Facilities Letter 25-04: hospice licensing (opens in a new tab)
- Medicare Care Compare (opens in a new tab)
- 42 CFR 418.21: Duration of hospice care coverage, election periods (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (844) 646-4434 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice