(

a) No person, political subdivision of the state, or other governmental agency, that is not operating a hospice as of January 1, 1991, shall establish or operate a hospice without first obtaining a license under this chapter. (

b) Any person, political subdivision of the state, or other governmental agency, that is operating a hospice as of January 1, 1991, may continue to operate the hospice only under the following conditions:

(1) The person, political subdivision of the state, or other governmental agency shall apply to the state department for a license under this

chapter within days after forms for the application of licensure under this

chapter are available from the state department.

(2) The person, political subdivision of the state, or other governmental agency shall cease calling or referring to itself as a hospice upon the final decision of the director upholding the state department’s denial of an application for licensure under this chapter. (

c) Nothing in this

chapter shall preclude the ongoing use of the title “volunteer hospice” by those organizations that satisfy all of the following:

(1) They do not provide skilled nursing services.

(2) They do not charge patients or families for hospice services, and they do not receive third-party insurance payments for services rendered.

(3) They satisfy the disclosure requirements specified in subdivision (

c) of

Section 1748. (

d) A small and rural hospice is exempt from the licensing provisions of this

chapter and the disclosure requirements of subdivision (

c) of

Section 1748. A small and rural hospice may provide skilled nursing services and may use the title “volunteer hospice.” For purposes of this chapter, a “small and rural hospice” means a hospice that provides services to less than patients per year, does not charge for services, does not receive third-party payment for services rendered, and is not located in a standard metropolitan statistical area.