Do hospice volunteers need a background check?
Yes — for volunteers with direct patient contact or access to patient records. Here is the federal rule, how it reaches volunteers, what your state adds, and how to keep the documentation ready.
- Federal rule explained plainly
- All 50 states + D.C. covered
- Tracking built into Volunteer Ledger
Yes — for volunteers who have direct patient contact or access to patient records. The federal hospice Conditions of Participation reach those volunteers through the way the rule defines "employee." Volunteers who never see patients or charts — purely clerical, fundraising, or office help — are not swept in by the federal rule, though some states are broader. Many states also require it outright.
Is it a federal requirement?
Yes — and the mechanism matters, because the obligation runs through a definitional cross-reference rather than a section written specifically about volunteers.
42 CFR §418.114(d) requires a hospice to obtain criminal background checks on "employees" who have direct patient contact or access to patient records. The hospice Conditions of Participation define that word in 42 CFR §418.3, and the definition of "Employee" expressly includes "a volunteer under the jurisdiction of the hospice." Because §418.3 opens with "For purposes of this part," that definition governs the word "employee" throughout Part 418 — including §418.114 — so patient-facing volunteers are within the federal requirement.
It is worth being honest about enforcement: CMS's surveyor guidance (State Operations Manual Appendix M, tag L796) tells surveyors to verify that checks were obtained "in accordance with §418.114(d)" but does not single out volunteers as an explicit survey step, and its example personnel list focuses on paid clinical roles. This is a real federal requirement on the books — not an aggressive enforcement target — but an obligation that applies.
One clarification worth noting: the §418.78 "Volunteers" condition itself contains no background-check language. The obligation comes from §418.114(d) read together with the §418.3 definition — not from the volunteers condition directly.
- 42 CFR §418.114(d) — the background-check requirement for hospice "employees" with patient contact or records access
- 42 CFR §418.3 — defines "Employee" to include "a volunteer under the jurisdiction of the hospice"
Which volunteers are covered?
Coverage is scoped to the volunteer's activity, not their title. The question is whether they have direct patient contact or access to patient records.
Covered by the federal rule
- Patient visiting and companionship volunteers
- Hospice-house volunteers who interact with patients
- Pet-therapy volunteers working with patients
- Any volunteer who can view a patient's chart or records
Not covered by the federal rule
- Office and clerical volunteers with no patient contact
- Fundraising and event volunteers
- Administrative volunteers with no records access
Your state may still require a check for these roles — see below.
State-by-state overlay
Federal regulation §418.114(d)(2) directs hospices to obtain background checks "in accordance with State requirements," and where no state requirement exists, within three months covering every state the person lived or worked in over the prior three years. States control the mechanics — timing, type of check, fingerprinting, registries, and disqualifying offenses — and their own rules vary widely. This is a general guide, not legal advice; confirm your state's current requirement with your licensing authority.
Require background checks for volunteers outright
17 statesThese states require background checks for hospice or health-facility volunteers under their own law, independent of the federal rule.
Alaska, Arizona, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Michigan, Minnesota, New Hampshire, Oklahoma, Oregon, South Carolina, Texas, Washington, Wyoming
Conditional or partial requirement
12 statesCovered through a definitional cross-reference, a supervision or hours carve-out, a registry-only check, or agency interpretation — not a blanket volunteer mandate.
Arkansas, Florida, Kentucky, Massachusetts, Missouri, Nebraska, New Mexico, Pennsylvania, Tennessee, Utah, West Virginia, Wisconsin
Not required by state law
21 states + D.C.The state's own law does not require a background check for volunteers. For patient-facing volunteers, the federal floor (§418.114 + §418.3) still applies. Five of these — New York, Ohio, Nevada, Virginia, and D.C. — expressly exclude volunteers from their state rule. California's 2026 hospice regulations (22 CCR §§74800–74908) require volunteers to clear federal and state exclusion lists and complete health screenings, but do not impose a criminal background check — so there too it is the federal floor that reaches patient-facing volunteers.
Alabama, California, Colorado, Delaware, Iowa, Idaho, Kansas, Louisiana, Maryland, Mississippi, Montana, Nevada, New Jersey, New York, North Carolina, Ohio, Rhode Island, South Dakota, Vermont, Virginia, Washington D.C.
State rule unclear or not machine-readable
1 stateHospices in this state should confirm the current requirement directly with the state licensing authority. North Dakota's hospice licensing rules are not machine-readable; its hospice statute does not appear to impose a volunteer background-check requirement, which would leave the federal floor in place for patient-facing volunteers.
North Dakota
This is a general reference compiled from state hospice and health-facility rules, not legal advice — confirm your state's current requirement and procedure with your state licensing authority.
How Volunteer Ledger helps
Volunteer Ledger does not perform background checks and does not guarantee compliance. What it does is keep the documentation organized so that when a surveyor, an administrator, or a state inspector asks, the record is ready — not buried in a spreadsheet or a filing cabinet.
Flag which volunteers need a check
Tag volunteers by service area — patient visiting, hospice house, pet therapy — and Volunteer Ledger shows you which ones fall under the patient-contact requirement and need a check on file. The scope question becomes a filter, not a manual audit of your roster.
Record completion, result, and date
Log the date the check was completed, the result, and optionally store the document securely. Every record is dated and attributed, so the audit trail exists without anyone constructing it by hand at survey time.
See who is missing or coming up for renewal
When background checks have expiration windows — many states require periodic renewal — Volunteer Ledger surfaces the upcoming and overdue ones before they become a gap in the record that a surveyor has to ask about.
Pull a survey-ready volunteer file
When survey arrives, each volunteer's credential record — background check date, result, and service area — sits in the same file as their hours and contact information. One place, one export, ready to hand over.
See how credential tracking works in context: Hospice volunteer tracking software overview
Background check requirements, answered
Do hospice volunteers need a background check?
For volunteers with direct patient contact or access to patient records, yes. A federal requirement applies through the way 42 CFR §418.3 defines "employee" to include volunteers under the jurisdiction of a hospice, bringing patient-facing volunteers within the background-check rule at 42 CFR §418.114(d). Volunteers who never see patients or patient records — purely office, clerical, or fundraising roles — are not covered by the federal rule, though many states require background checks for those volunteers anyway.
Is it federal or just state law?
Both. There is a federal floor for patient-facing volunteers through 42 CFR §418.114(d) read with the 42 CFR §418.3 "employee" definition. On top of that, individual states add their own requirements — some require background checks for all volunteers outright, some apply only in certain circumstances, and a handful expressly exclude volunteers from their own state rules while the federal floor still applies to the patient-facing ones.
Which volunteers are covered?
The federal requirement applies to volunteers who have direct patient contact or access to patient records. This includes patient visiting and companionship volunteers, hospice-house volunteers who interact with patients, pet-therapy volunteers working with patients, and any volunteer who can see a patient's chart. It does not apply — under the federal rule — to purely administrative, clerical, fundraising, or event volunteers who have no patient contact and no access to records. Your state may still require a check for those roles.
Does CMS actively survey for volunteer background checks?
The requirement is on the books. CMS surveyor guidance (State Operations Manual Appendix M, tag L796) directs surveyors to verify that background checks were obtained in accordance with 42 CFR §418.114(d), but the guidance does not single out volunteers as an explicit survey step and its example personnel list focuses on paid clinical roles. The obligation is real and documented — but it is not an aggressive survey focus the way the clinical participation ratio is.
Does Volunteer Ledger run the background check?
No. Volunteer Ledger does not perform background checks and does not guarantee compliance. You run the check — directly or through a screening vendor — and Volunteer Ledger helps you track and document it: flagging which volunteers need a check based on their service areas, recording completion date and result, and surfacing who is missing or coming up for renewal. The documentation stays organized so it is ready when a surveyor asks.
This page is general information, not legal advice. Hospice volunteer background-check requirements come from federal regulation and your state's law, and they change — confirm your specific obligations with your state hospice licensing authority and your accreditor.
Keep the documentation ready before survey asks for it.
Start a free 45-day trial, import your volunteer roster, flag the roles that need a check, and have a survey-ready credential record from day one. No credit card, no setup call.