Oregon Hospice Licensing Is Changing: Where SB 1575 Implementation Stands
by Jamie Daugherty, Executive Director

Earlier this year, Oregon took a significant step toward strengthening oversight of hospice providers when lawmakers passed Senate Bill 1575. Now, the focus has shifted from the Legislature to the Oregon Health Authority, where the details of implementation are taking shape.

And those details matter.

SB 1575 established new requirements for hospice licensure intended to strengthen screening of new providers while protecting access to hospice services across Oregon. The law requires additional review of ownership, leadership qualifications, regulatory history and other information when an organization applies for an initial hospice license.

The law also temporarily limits OHA's ability to issue new initial hospice licenses while the new rules are developed. Importantly, this is not an absolute moratorium. SB 1575 includes exceptions for existing hospice providers expanding into new service areas, changes of ownership, certain licensed health care and residential providers, and applicants proposing to serve underserved areas or populations.

Rulemaking Is Well Underway

OHA convened a Rulemaking Advisory Committee in September and has now held three meetings, on September 11, September 25 and October 5. The committee has been reviewing proposed changes to Oregon's hospice licensing rules, OAR 333-035. OHA's stated goal is to have the new rules completed and operative by January 1, 2027. 

The discussions have covered several issues that could have practical implications for Oregon hospices, including:

  • Initial and renewal application requirements
  • Disclosure of ownership interests
  • Review of regulatory and performance history
  • Criminal background checks
  • Administrator and medical director qualifications
  • CAHPS submission requirements
  • Geographic service areas
  • Licensing and late fees

Some of these issues are straightforward implementation of SB 1575. Others require OHA to determine exactly how the statutory requirements will work in practice.

For example, discussions have addressed how far OHA should look through complex ownership structures, what regulatory history should be significant enough to affect a licensing decision, and how administrator and medical director qualifications should be structured without creating unnecessary barriers for rural providers.

Rural Access Remains an Important Consideration

One issue that deserves particular attention is how the new requirements affect rural Oregon.

During the rulemaking discussions, participants have raised concerns about licensing costs, availability of qualified medical directors and administrators, geographic requirements, and the difficulty of applying standards designed for larger organizations to small or rural hospice programs.

OHA has also been considering how licensing fees should be structured. SB 1575 allows OHA to establish fees through rule and permits a graduated structure based on factors such as patient census or revenue. During the September 25 meeting, participants discussed whether a fee structure could account for the circumstances of smaller and rural providers.

That is an important conversation. Strong oversight and access to care are not competing goals. Oregon needs both.

What Existing Hospices Should Be Doing

For currently licensed hospice providers, this is not a reason to make immediate operational changes based on draft language.

It is, however, a reason to pay attention.

The rules under discussion include requirements affecting license renewals as well as initial applicants. SB 1575 also gives OHA authority to consider certain performance history and requires qualifying hospice operators to have submitted the previous year's CAHPS results to CMS unless exempt.

Providers should begin thinking about whether their organizational records, ownership information, leadership documentation, regulatory history and CAHPS reporting are readily available and accurate.

Just as importantly, providers should watch the next stage of the process.

OHA intends to move from the advisory committee process into formal rulemaking, including a public hearing and public comment period. OHA has indicated that timing is important: if proposed rules cannot be posted by December 1, permanent rulemaking could be delayed until June or July 2027, with the licensing moratorium remaining in place longer. 

OAHC Will Continue to Follow the Process

SB 1575 was never intended simply to create more paperwork. The goal is to protect patients and families, strengthen the integrity of Oregon's hospice system and make it more difficult for bad actors to enter the market—without creating unnecessary barriers for legitimate providers or reducing access to care.

The legislation established the framework. The rulemaking process will determine much of how that framework actually operates.

OAHC will continue following OHA's work closely and will keep members informed as proposed rules, public comment opportunities and implementation guidance become available.

For Oregon hospice providers, now is the time to stay engaged. The decisions being made during this process will help shape hospice licensing in our state for years to come.