WAC 246-310-290
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.
(1) Definitions.
(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 (2)(d).
(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 and 70.38 RCW. 03-07-096, § 246-310-290, filed 3/19/03, effective 4/19/03.]