What are the Hospice Conditions of Participation (CoPs)?

The Hospice Conditions of Participation are the federal regulations at 42 CFR §418. Every Medicare-certified hospice must meet them to remain certified. Surveyors from a State Survey Agency or an Accrediting Organization (AO) verify compliance every 36 months.

By Goodwin Hospice Academy Editorial Team· Published February 16, 2026·Last reviewed February 16, 2026· 5 min read

CoPs, in one sentence

The Hospice CoPs are the federal minimum standards for hospice care, structure, and operations under 42 CFR §418, subparts A through F.

Key CoP structure

Subpart A: General provisions and definitions. Subpart B: Eligibility, election, and duration of benefits. Subpart C: Conditions of participation (patient care, organizational, and personnel). Subpart D: Coinsurance. Subpart F: Covered services. Subpart G: Payment.

Most-cited CoPs

Common survey citations concentrate around §418.52 (patient rights), §418.54 (initial and comprehensive assessment), §418.56 (interdisciplinary group and plan of care), §418.100 (organization and administration), and §418.76 (aide qualifications and supervision).

Survey cadence

Every Medicare-certified hospice is surveyed at least every 36 months. Complaint surveys and follow-up surveys may occur more frequently. Accrediting Organizations (Joint Commission, ACHC, CHAP) run their own survey rhythms in lieu of State Survey Agency surveys.

Frequently asked questions

Who enforces the CoPs?

CMS delegates survey activity to State Survey Agencies and CMS-approved Accrediting Organizations. Deficiencies are cited at various severity levels, from standard-level (correctable within a specified time) to condition-level (immediate jeopardy or condition-out-of-compliance).

What happens after a survey?

If deficiencies are cited, the hospice submits a plan of correction (POC), typically within 10 days. Failure to respond adequately can trigger enforcement actions up to and including termination from Medicare participation.

Are the CoPs the same as state licensure?

No. State hospice licensure is a separate framework administered by state health departments. Many state licensure requirements mirror or exceed the federal CoPs; both must be met.

Sources & further reading

Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current CMS guidance.

Keep going.

Save your progress, earn achievements, and get personalized next-step learning with a free Goodwin Hospice Academy account.

Create your free Goodwin account Back to Knowledge Center