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Hospice services—Standards and need forecasting method.
The following rules apply to any in-home services agency licensed to provide hospice services which has declared an intent to become medicare certified as a provider of hospice services in a designated service area.
(a) "ADC" means average daily census and is calculated by:
(i) Multiplying projected annual agency admissions by the most recent average length of stay in Washington (based on Centers for Medicare and Medicaid Services (CMS) data) to derive the total annual days of care; and
(ii) Dividing this total by three hundred sixty-five (days per year) to determine the ADC.
(b) "Current supply of hospice providers" means:
(i) Services of all providers that are licensed and medicare certified as a provider of hospice services or that have a valid (unexpired) certificate of need but have not yet obtained a license; and
(ii) Hospice services provided directly by health maintenance organizations who are exempt from the certificate of need program. Health maintenance organization services provided by an existing provider will be counted under (b)(i) of this subsection.
(c) "Current hospice capacity" means:
(i) For hospice agencies that have operated (or been approved to operate) in the planning area for three years or more, the average number of admissions for the last three years of operation; and
(ii) For hospice agencies that have operated (or been approved to operate) in the planning area for less than three years, an ADC of thirty-five and the most recent Washington average length of stay data will be used to calculate assumed annual admissions for the agency as a whole for the first three years.
(d) "Hospice agency" or "in-home services agency licensed to provide hospice services" means a person administering or providing hospice services directly or through a contract arrangement to individuals in places of temporary or permanent residence under the direction of an interdisciplinary team composed of at least a nurse, social worker, physician, spiritual counselor, and a volunteer and, for the purposes of certificate of need, is or has declared an intent to become medicaid eligible or certified as a provider of services in the medicare program.
(e) "Hospice services" means symptom and pain management provided to a terminally ill individual, and emotional, spiritual and bereavement support for the individual and family in a place of temporary or permanent residence and may include the provision of home health and home care services for the terminally ill individual.
(f) "Planning area" means each individual county designated by the department as the smallest geographic area for which hospice services are projected. For the purposes of certificate of need, a planning or combination of planning areas may serve as the service area.
(g) "Service area" means, for the purposes of certificate of need, the geographic area for which a hospice agency is approved to provide medicare certified or medicaid eligible services and which consist of one or more planning areas.
(2) The department shall review hospice applications using the concurrent review cycle in this section, except when the sole hospice provider in the service area ceases operation. Applications to meet this need may be accepted and reviewed in accordance with the regular review process.
(3) Applications must be submitted and reviewed according to the following schedule and procedures:
(a) Letters of intent must be submitted between the first working day and last working day of September of each year.
(b) Initial applications must be submitted between the first working day and last working day of October of each year.
(c) The department shall screen initial applications for completeness by the last working day of November of each year.
(d) Responses to screening questions must be submitted by the last working day of December of each year.
(e) The public review and comment for applications shall begin on January 16 of each year. If January 16 is not a working day in any year, then the public review and comment period must begin on the first working day after January 16.
(f) The public comment period is limited to ninety days, unless extended according to the provisions of WAC 246-310-120
(2)(d). The first sixty days of the public comment period must be reserved for receiving public comments and conducting a public hearing, if requested. The remaining thirty days must be for the applicant or applicants to provide rebuttal statements to written or oral statements submitted during the first sixty-day period. Also, any interested person that:
(i) Is located or resides within the applicant's health service area;
(ii) Testified or submitted evidence at a public hearing; and
(iii) Requested in writing to be informed of the department's decision, shall also be provided the opportunity to provide rebuttal statements to written or oral statements submitted during the first sixty-day period.
(g) The final review period shall be limited to sixty days, unless extended according to the provisions of WAC 246-310-120
(4) Any letter of intent or certificate of need application submitted for review in advance of this schedule, or certificate of need application under review as of the effective date of this section, shall be held by the department for review according to the schedule in this section.
(5) When an application initially submitted under the concurrent review cycle is deemed not to be competing, the department may convert the review to a regular review process.
(6) Hospice agencies applying for a certificate of need must demonstrate that they can meet a minimum average daily census (ADC) of thirty-five patients by the third year of operation. An application projecting an ADC of under thirty-five patients may be approved if the applicant:
(a) Commits to maintain medicare certification;
(b) Commits to serve one or more counties that do not have any medicare certified providers; and
(c) Can document overall financial feasibility.
(7) Need projection. The following steps will be used to project the need for hospice services.
(a) Step 1. Calculate the following four statewide predicted hospice use rates using CMS and department of health data or other available data sources.
(i) The predicted percentage of cancer patients sixty-five and over who will use hospice services. This percentage is calculated by dividing the average number of hospice admissions over the last three years for patients the age of sixty-five and over with cancer by the average number of past three years statewide total deaths sixty-five and over from cancer.
(ii) The predicted percentage of cancer patients under sixty-five who will use hospice services. This percentage is calculated by dividing the average number of hospice admissions over the last three years for patients under the age of sixty-five with cancer by the current statewide total of deaths under sixty-five with cancer.
(iii) The predicted percentage of noncancer patients sixty-five and over who will use hospice services. This percentage is calculated by dividing the average number of hospice admissions over the last three years for patients age sixty-five and over with diagnoses other than cancer by the current statewide total of deaths over sixty-five with diagnoses other than cancer.
(iv) The predicted percentage of noncancer patients under sixty-five who will use hospice services. This percentage is calculated by dividing the average number of hospice admissions over the last three years for patients under the age of sixty-five with diagnoses other than cancer by the current statewide total of deaths under sixty-five with diagnoses other than cancer.
(b) Step 2. Calculate the average number of total resident deaths over the last three years for each planning area.
(c) Step 3. Multiply each hospice use rate determined in Step 1 by the planning areas average total resident deaths determined in Step 2.
(d) Step 4. Add the four subtotals derived in Step 3 to project the potential volume of hospice services in each planning area.
(e) Step 5. Inflate the potential volume of hospice service by the one-year estimated population growth (using OFM data).
(f) Step 6. Subtract the current hospice capacity in each planning area from the above projected volume of hospice services to determine unmet need.
(g) Determine the number of hospice agencies in the proposed planning area which could support the unmet need with an ADC of thirty-five.
(8) In addition to demonstrating need under subsection (7) of this section, hospice agencies must meet the other certificate of need requirements including WAC 246-310-210
- Determination of need, WAC 246-310-220
- Determination of financial feasibility, WAC 246-310-230
- Criteria for structure and process of care, and WAC 246-310-240
- Determination of cost containment.
(9) If two or more hospice agencies are competing to meet the same forecasted net need, the department shall consider at least the following factors when determining which proposal best meets forecasted need:
(a) Improved service in geographic areas and to special populations;
(b) Most cost efficient and financially feasible service;
(c) Minimum impact on existing programs;
(d) Greatest breadth and depth of hospice services;
(e) Historical provision of services; and
(f) Plans to employ an experienced and credentialed clinical staff with expertise in pain and symptom management.
(10) Failure to operate the hospice agency in accordance with the certificate of need standards may be grounds for revocation or suspension of an agency's certificate of need, or other appropriate action.
[Statutory Authority: Chapters 70.127
RCW. WSR 03-07-096, § 246-310-290, filed 3/19/03, effective 4/19/03.]