Alabama Administrative Code
Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY
Chapter 410-2-3 - SPECIALTY SERVICES
Section 410-2-3-.10 - In Home Hospice Services
Universal Citation: AL Admin Code R 410-2-3-.10
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Discussion
(a) Hospice care is a choice made to enhance
end of life. Hospice focuses on caring and comfort for patients and not
curative care. In most cases, care is provided in the patient's place of
residence. It is the intent of this section to address health planning concerns
relating to hospice services provided in the patient's place of residence. For
coverage of hospice services provided on an inpatient basis, please see Section
410-2-4-.15.
(2) Definitions
(a) Hospice Program. A "Hospice Program" is
defined as a public agency, private organization, or subsidiary of either of
these that is primarily engaged in providing Hospice Care to the terminally ill
individual and families and is separately licensed by the State of Alabama and
certified by Centers for Medicare/Medicaid Services (CMS) for the provision of
all required levels of Hospice Care.
(b) Hospice. "Hospice" is a coordinated
program providing a continuum of home and inpatient care for the terminally ill
patient and family and/or significant other. It employs an interdisciplinary
team acting under the direction of an identifiable hospice administration. The
program provides palliative and supportive care to meet the special needs
arising out of the physical, emotional, spiritual, social and economic stresses
which are experienced during the final stages of illness and bereavement. The
care is available twenty-four hours a day, seven days a week.
(3) Availability and Accessibility
(a) Hospice services must be obtainable by
all of the residents of the State of Alabama. The care must be available to all
terminally ill persons and their families without regard to age, gender,
national origin, disability, diagnosis, cost of care, ability to pay or life
circumstances.
(b) Physicians and
other referral sources may be unfamiliar with the total scope of services
offered by hospice; accessibility may be limited due to a lack of awareness.
Every provider should provide an active community informational program to
educate consumers and professionals to the availability, nature, and extent of
their hospice services provided.
(4) Inventory
(a) As of this date, hospice services are
available in all sixty-seven (67) counties. Hospice programs are licensed by
the Alabama Department of Public Health.
(5) Quality
(a) Quality is that characteristic which
reflects professionally and technically appropriate patient services. Each
provider must establish mechanisms for quality assurance including procedures
for resolving concerns identified by patients, physicians, family members, or
others in patient care or referral. Providers should also develop internal
quality assurance and grievance procedures.
(b) Providers are encouraged to achieve a
utilization level which promotes cost effective service delivery.
(c) Hospice programs are required to meet or
exceed the current Medicare Hospice Conditions of Participation, as adopted by
CMS, and codified in the Code of Federal Regulations, along with State
Licensure Regulations of the Department of Public Health.
(6) In Home Hospice Services Need Methodology
(a) Purpose. The purpose of this in home
hospice services need methodology is to identify, by county, the number of
hospice providers needed to assure the continued availability, accessibility,
and affordability of quality care for residents of Alabama. A corporate entity
must obtain a CON for each parent. Relocation within the CON Authorized service
area of a branch or parent provider does not require applying for a new
CON.
(b) General. Formulation of
this methodology was accomplished by a committee of the Statewide Health
Coordinating Council (SHCC). The committee, which provided its recommendations
to the SHCC, was composed of providers and consumers of health care, and
received input from hospice providers and other affected parties. Only the
SHCC, with the Governor's final approval, can make changes to this methodology,
except that SHPDA staff shall annually update statistical information to
reflect more current population and utilization. Adjustments are addressed in
paragraph (e) below.
(c) Basic
Methodology
1. Need Assessment for Hospice
Services
2. The need for additional
Hospice Services shall be calculated as follows:
HPR = Hospice Deaths by County/Total Deaths by County
Where as:
HPR= The Hospice Penetration Rate
Hospice Deaths by County is defined as the total deaths of those served in hospice care for the specific county. Data shall be obtained through all licensed Alabama Hospice providers who are required to collect and provide data to SHPDA annually.
Total Deaths by County is defined as the total deaths from all causes in the specific county. Data shall be obtained from the Alabama Department of Public Health Center for Health Statistics.
This formula is recommended by the National Hospice and Palliative Care Organization which utilizes this formula to report national hospice penetration rates. In completing the formula to establish need, SHPDA will match the year of hospice deaths with the most recent year of total deaths as provided by the Alabama Department of Public Health Center for Health Statistics.
3. Review
Criteria. An application to establish or expand hospice services in a county
shall be consistent with this Plan if:
(i) The
Hospice penetration rate in the proposed county is less than forty percent
(40%).
(ii) Each approved hospice
agency in the proposed county has been operational for at least thirty-six (36)
months in Alabama; and
(iii) Only
one (1) application may be approved in each county during any approval cycle as
defined by the Statewide Health Coordinating Council, or as implemented by
SHPDA.
4. The SHCC has
determined that additional information is required in order to conduct a
thorough examination of both the appropriateness and accuracy of any need
projections derived from this methodology. Therefore, no determination of need
shall be made by SHPDA for a minimum of two (2) years following the effective
date of this Plan. During this two (2) year period, SHPDA shall review the data
collected on the Annual Report for Hospice Providers (form HPCE4) to determine
the appropriateness and accuracy of the methodology provided in this section.
SHPDA shall also investigate and analyze the impact of utilizing only the total
number of "hospice eligible" deaths, rather than the total number of deaths in
a county, to determine the impact of utilizing an alternate value as a part of
the methodology. Further, SHPDA shall work with the SHCC to determine the
impact of other aspects of this section to determine whether additional changes
to this section, beyond potential changes to the methodology, should be
considered by the SHCC.
(d) Planning Policies
1. SHPDA staff shall collect data from all
licensed hospice providers on an annual basis, on a survey instrument developed
by SHDPA staff with the advice and consent of the Health Care Information and
Data Council. The survey instrument shall be designed to collect all data
necessary to support the In-Home Services Need methodology discussed
above.
2. Hospice need projections
will be based on a three-year planning horizon.
3. Planning will be on a countywide
basis.
(e) Adjustments.
The need for hospice providers, as determined by the methodology, is subject to
adjustments by the SHCC. The SHCC may adjust the need for hospice services in
an individual county or counties if an applicant documents the existence of at
least one of the following conditions:
1.
Absence of services by a hospice certified for Medicaid and Medicare in the
proposed county, and evidence that the applicant will provide Medicaid and
Medicare-certified hospice services in the county; or
2. Absence of services by a hospice in the
proposed county for patients regardless of ability to pay, and evidence that
the applicant will provide services for patients regardless of ability to pay.
For a listing of In-Home Hospice providers or the most current statistical need projections in Alabama contact the Data Division as follows:
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MAILING ADDRESS |
STREET ADDRESS |
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(U. S. Postal Service) |
Commercial Carrier) |
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PO BOX 303025 |
100 NORTH UNION STREET, SUITE 870 |
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MONTGOMERY, AL 36130-3025 |
MONTGOMERY, AL 36104 |
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TELEPHONE: |
FAX: |
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(334) 242-4103 |
(334) 242-4113 |
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EMAIL: |
WEBSITE: |
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data.submit@shpda.alabama.gov |
Author: Statewide Health Coordinating Council (SHCC)
Statutory Authority: Code of Ala. 1975, § 22-21-260(4).
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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