Medical Director

Job Description

Reports To:

Administrator

Appointed By:

Governing Body (in writing)

Employment Type:

Employed or contracted; full-time or part-time

Regulatory Ref:

22 CCR §§ 74800(a)(37), 74856, 74860, 74868, 74880 | 42 CFR Part 418 | ACHC Hospice Standards

Effective Date:

June 22, 2026

POSITION SUMMARY

The Medical Director is a licensed physician and surgeon appointed in writing by the Governing Body who is responsible for the overall medical direction of the hospice program. The Medical Director provides oversight of physician services by complementing attending physician care, acting as a medical resource to the interdisciplinary team, assuring continuity of hospice medical services, and assuring appropriate measures to control patient symptoms. The Medical Director ensures that all medical components of care meet applicable federal and California state requirements and ACHC accreditation standards.

The Medical Director serves as a hospice champion in the community, promoting and representing the program to physicians, physician groups, discharge planners, referral sources, community health organizations, and potential donors, as appropriate. The Medical Director may be employed or contracted with the hospice on a full-time or part-time basis.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Devoting best ability to the proper management and medical direction of the hospice program.
• Providing overall medical direction to the program; assuring that established policies, bylaws, rules, and regulations of the organization are followed.
• Adhering to requirements, terms, and conditions required by the Medicare Conditions of Participation (42 CFR Part 418), ACHC standards, and all applicable federal and California state statutes governing the provision of hospice services.
• Establishing and continually reviewing policies and procedures related to patient care, medical education, and emergency procedures.
• Developing and reviewing, in cooperation with the Administrator and/or DPCS, criteria to monitor the quality of education programs provided to physicians, personnel, and volunteers.
• Evaluating QAPI plans and monitoring to identify medical education needs; participating in QAPI teams and activities as needed.
• Proposing organizational programs to address identified needs, with input from appropriate specialists.
• Working with the Administrator and/or DPCS to determine the impact of implemented programs on quality of care.
• Serving as a hospice champion in the community; acting as a liaison to community physicians by providing consultation and education regarding hospice and palliative care admission criteria.
• Providing training on medical aspects of caring for terminally ill patients to physicians, personnel, and volunteers.
• Consulting with attending physicians regarding pain and symptom management for hospice patients; managing oversight of patients' medications and treatments.
• Acting as medical resource to the hospice interdisciplinary team; attending IDT meetings and working collaboratively with the team.
• In conjunction with the attending physician and IDT, reviewing and updating the plan of care at least every 15 days, or more frequently as needed, per 22 CCR § 74872.
• Documenting care provided in the patient's clinical record, providing evidence of progression of the end-stage disease process.
• Acting as primary physician for patients whose attending physicians desire to relinquish that care or are not available.
• Maintaining current knowledge of the latest research and trends in hospice care and pain/symptom management.
• Reviewing and developing protocols for treatment; proposing current options for interventions.
• Developing and implementing procedures and protocols regarding OSHA standards, including the handling of hazardous medications.
• Demonstrating knowledge in communications and counseling patients and family/caregivers dealing with end-of-life issues.
• Participating in resolution of interpersonal conflict and issues of clinical and ethical concern.
• Ensuring competent physician services are routinely available on a 24-hour basis to meet general medical needs of hospice patients to the extent not met by the attending physician.
• Assisting with evaluation of protocols and procedures with respect to quality and cost outcomes.

Regulatory-Specific Responsibilities (22 CCR §§ 74856, 74860, 74864, 74868, 74872):

• Certifying and recertifying terminal illness for all patients admitted to hospice, in consultation with the attending physician, prior to providing care and for all subsequent benefit periods (§ 74860(c)).
• Ensuring each initial certification of terminal illness includes: an individualized clinical narrative supporting life expectancy of 12 months or less; an attestation statement immediately above the Medical Director's signature; and all clinical information supporting the medical prognosis (§ 74860(c)(3)).
• Consulting on comprehensive assessments and serving as the certifying/consulting physician when a patient does not have an attending physician or the attending is unavailable (§ 74864(b)).
• Approving and signing plans of care when the attending physician is unavailable (§ 74868(f)).
• Approving, in writing, all modifications proposed to a patient's plan of care (§ 74868(g)).
• Performing face-to-face encounter assessments within 30 days of the third and subsequent hospice benefit certification periods, and attesting to the encounter. (A nurse practitioner may complete the encounter and report findings to the Medical Director.)
• Notifying CDPH within 10 business days of any change in Medical Director or Medical Director Designee, by submitting the required change of Medical Director application per § 74828(b).
• Ensuring any vacancy in the Medical Director or Medical Director Designee positions is filled within 60 days of occurrence.

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this position. The Medical Director may be requested to perform job-related tasks other than those stated in this description.

POSITION QUALIFICATIONS

Minimum Regulatory Requirements — California (22 CCR § 74856(b)):

The following qualifications are mandated by California emergency regulations effective June 22, 2026. All requirements must be met:

Current and valid license as a physician and surgeon issued by the Medical Board of California or the Osteopathic Medical Board of California — without restriction or subject to any disciplinary or corrective action.

Minimum of two (2) years of full-time supervisory or managerial experience in a hospice, home health agency, or providing palliative care to patients within the last five (5) years.

No disciplinary action taken against the individual within the last seven (7) years (22 CCR § 74832(b)).

Must not hold concurrent employment or contract as Medical Director or Medical Director Designee at other hospices, except that concurrent employment or contract at no more than three (3) hospices is permitted if all are located in the same rural area (22 CCR § 74856(f)-(g)).

Additional Requirements — All Medical Directors:

Maintains controlled substances registration with state and federal authorities.

Not excluded from participating in the Medicare or Medi-Cal programs (OIG List of Excluded Individuals and Entities).

Preferred Qualifications:

Board certification as a hospice medical director through the Hospice Medical Director Certification Board (HMDCB); OR certification in Hospice and Palliative Medicine by a member board of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

Substantial experience in hospice or palliative care, with demonstrated knowledge of end-of-life symptom management, pain management, and the Medicare hospice benefit.

Participation in ongoing medical education activities related to the medical care of hospice and palliative care patients.

Strong skills in communications and counseling patients and families dealing with end-of-life issues.

IMPORTANT — Certification Documentation: If the Medical Director holds HMDCB or ABMS/AOA hospice and palliative medicine certification, proof of certification (type, certification number, and expiration date) must be submitted to CDPH per 22 CCR § 74828. Contract arrangements must specify the individual physician who assumes Medical Director responsibilities per § 74856(h)(2).

EMPLOYMENT AND CONTRACT OPTIONS (22 CCR § 74856(D)-(H))

The Medical Director may be engaged through any of the following arrangements:

Direct employment by the hospice (full-time or part-time).

Contract with a self-employed physician.

Contract with a physician employed by a professional entity or physician's group — the contract must name the specific physician who assumes the responsibilities and obligations of the Medical Director.

ORIENTATION AND TRAINING REQUIREMENTS (22 CCR § 74880)

New Hire Orientation — All Management Personnel:

Must complete a minimum of 20 hours of new hire orientation training within 60 days of hire, as provided by the hospice. Topics include regulatory agency oversight, licensing requirements, basic hospice services, hospice administration, human resource management, and comprehensive review of policies and procedures and patient care requirements.

First-Time Medical Director Training:

An individual who has never previously served as Medical Director or Medical Director Designee at a California hospice must complete ONE of the following within the first 12 months of hire:

A total of 24 hours of educational training covering: providing medical direction and support for hospice patients and families; effective leadership and communication; ethical and professional conduct; and hospice regulatory requirements; OR

A hospice certification program covering: medical direction and support for patients and families; medical knowledge including medication and pain management, diagnosis and symptom management, hospice settings, and patient assessments; medical leadership and communication including ongoing education of hospice personnel; ethical and professional conduct; and hospice regulatory requirements.

Annual Training — All Management Personnel:

Minimum of 12 hours of annual training (each 12-month period from date of hire), covering hospice policies and procedures and patient care requirements per § 74880(e).

REGULATORY COMPLIANCE NOTE: The qualifications set forth in 22 CCR § 74856, effective June 22, 2026 (CDPH DPH-18-002E), establish the legally required minimum standards for this position. Any individual appointed to this position must affirmatively meet all regulatory minimums prior to appointment. Contract arrangements must comply with § 74856(h). This job description supersedes prior versions to the extent any prior version conflicts with the current California emergency regulations.