Alabama Administrative Code
Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY ALABAMA STATE HEALTH PLAN 2014-2017
Chapter 410-2-4 - 2020-2023 Alabama State Health Plan - Facilities
Section 410-2-4-.15 - Inpatient Hospice Services
Universal Citation: AL Admin Code R 410-2-4-.15
Current through Register Vol. 42, No. 5, February 29, 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.
(b)
It is the intent of this section to address health planning concerns relating
to hospice services provided on an inpatient basis. For coverage of hospice
services provided primarily in the patient's place of residence, please see
Section
410-2-3-.10.
(c) A hospice program is required by federal
statutes as a Condition of Participation for hospice care (Title 42-Public
Health; Chapter IV - CMS, Department of Health and Human Services; Part 418 -
Hospice care; Section 418.98 or successors) and state statutes and regulations
(Alabama State Board of Health, Department of Public Health; Administrative
Code, Chapter 420-5-17; Section
420-5-17-.01 or
successors) to provide general inpatient level of care and inpatient respite
level of care as two of the four levels of hospice care. As per the Medicare
Condition of Participation (418.108), the total number of inpatient days used
by Medicare beneficiaries who elected hospice coverage in a 12-month period in
a particular hospice may not exceed twenty percent (20%) of the total number of
hospice days consumed in total by this group of beneficiaries.
(d) A hospice program per federal statute
must provide the inpatient levels of care that meets the conditions of
participation specified. The approved locations for inpatient hospice care are
a hospital, a skilled nursing facility ("SNF"), or an inpatient hospice
facility.
(e) A hospice program may
provide the inpatient levels of care in a freestanding inpatient facility/unit
which the hospice program owns and manages; through beds owned by either a
hospital or a skilled nursing facility ("SNF") but leased and managed by a
hospice program; or through contracted arrangements with another hospice
program's inpatient facility/unit.
(2) Definitions
(a) All definitions included in Section
410-2-3-.10
are incorporated herein by reference.
(b) Inpatient hospice facility. An "Inpatient
Hospice Facility" is defined as a freestanding hospice facility or a designated
unit, floor or specific number of beds located in a skilled nursing facility or
hospital leased or under the management of a hospice services
provider.
(c) General Inpatient
Level of Care. The general inpatient ("GIP") level of hospice care is intended
for short term acute care for pain control and symptomatic management. It is
not intended for long term care, residential or rehabilitation.
(d) Inpatient Respite Level of Care. The
inpatient respite level of care is limited per Medicare and Medicaid to a
maximum of five (5) days per episode for the purpose of family
respite.
(3) Availability and Accessibility
(a) Hospice services must be obtainable by
all of the residents of the State of Alabama.
(b) Physicians and other referral sources may
be unfamiliar with the total scope of services offered by hospice;
accessibility may be limited due to 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.
(c) In order for a SNF to
provide the inpatient levels of care for hospice patients, the SNF must meet
the standards specified by CMS regarding items such as required staffing of
facilities.
(d) Hospice agencies
are limited in establishing contracts with hospitals for the inpatient levels
of care. This is due to (a) the increased number of hospice providers that
request contracts from the same hospitals in the same service areas; and (b)
the reimbursement hospitals receive from the hospice providers for the hospice
inpatient levels of care.
(4) Inventory
(a) The establishment of an inpatient hospice
facility does not eliminate the need for contractual arrangements with
hospitals or SNF for inpatient levels of care. If the inpatient hospice
facility is at full capacity and a hospice patient is eligible for/requires
inpatient care, the hospice remains responsible to provide that level of care
at a contracted facility.
(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 the most cost-effective service
delivery.
(c) Hospice programs are
required to meet the most stringent 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) Inpatient Hospice Facility Need Methodology
(a) Purpose. The purpose of this inpatient
hospice services need methodology is to identify, by region, the number of
inpatient hospice beds needed to assure the continued availability,
accessibility, and affordability of quality of care for residents of
Alabama.
(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. The purpose of this need
methodology is to identify, by region, the number of inpatient hospice beds
needed to assure the continued availability, accessibility, and affordability
of quality hospice care for residents of Alabama.
2. The need methodology shall be calculated
by aggregating the reported average daily censuses (ADC) for all licensed
hospices in the designated Region, as reported annually to SHPDA, and
multiplying that aggregate regional ADC by 3%. The resulting figure shall be
the regional need.
3. Any increase
in regional need shall be limited to no more than five percent (5%) per year
with the sole exclusion of any need determined under Planning Policy 7 of this
section.
(d) Planning
Policies
1. Planning will be on a regional
basis. The attached listing defines the regional descriptions designated by the
SHCC.
2. An applicant for an
inpatient hospice facility must be an established and licensed hospice provider
and operational for at least thirty-six (36) months in Alabama.
3. An applicant for an inpatient hospice
facility must demonstrate the ability to comply with Medicare/Medicaid
regulations.
4. An applicant for an
inpatient hospice facility must demonstrate that existing inpatient hospice
beds in the region cannot meet the community demand for inpatient hospice
services.
5. An applicant for an
inpatient hospice facility must demonstrate that sharing arrangements with
existing facilities have been studied and implemented when possible.
6. An applicant for an inpatient hospice
facility may provide supplemental evidence in support of its application from
other data reported by licensed hospices on an annual basis to the State of
Alabama or the Federal Government.
7. Additional need may be shown in situations
involving a sustained high occupancy rate either for a region or for a single
facility. An applicant may apply for additional beds, and thus the
establishment of need above and beyond the standard methodology, utilizing one
of the following two policies. Once additional beds have been applied for under
one of the policies, that applicant shall not qualify to apply for additional
beds under either of these policies unless and until the established time
limits listed below have passed. All CON Authorized Inpatient Hospice beds
shall be included in consideration of occupancy rate and bed need.
(i) If the total combined occupancy rate for
all CON Authorized Inpatient Hospice facilities in a region is above 90% as
calculated by SHPDA using data reported on the most recent full year "Annual
Report for Hospice Providers (Form HPCE-4)" published by or filed with SHPDA,
an additional need of the greater of five percent (5%) of the current total CON
Authorized bed capacity of that region or five (5) total beds may be approved
for the expansion of an existing facility within that region. Once additional
bed need has been shown under this policy, no new need shall be shown in that
region based upon this rule for twenty-four (24) months following issuance of
the initial CON to allow for the impact of those beds in that region to be
analyzed. Should the initial applicant for beds in a region not apply for the
total number of beds allowed under this rule, the remaining beds would then be
available to be applied for by other providers in the region meeting the
conditions listed in this rule.
(ii) If the occupancy rate for a single
facility within a region is greater than 90% as calculated by SHPDA using data
reported on the most recent full year "Annual Report for Hospice Providers
(Form HPCE-4)" published by or filed with SHPDA, irrespective of the total
occupancy rate for all CON Authorized Inpatient Hospice facilities in that
region, up to five (5) additional beds may be approved within that region for
the expansion of that facility only. Once additional beds have been approved
under this policy, no new beds shall be approved for that facility for
twenty-four (24) months following issuance of the CON to allow for the impact
of those beds at that facility to be analyzed.
8. No application for the establishment of a
new, freestanding Inpatient Hospice facility shall be approved for fewer than
ten (10) beds to allow for the financial feasibility and viability of a
project. Need may be modified by the Agency for any county currently showing a
need of more than zero (0) but fewer than ten (10) total beds to a total need
of ten (10) new beds, but only in the consideration of an application for the
construction of a new, freestanding facility in a region in which no
freestanding Inpatient Hospice currently exists. Need shall not be adjusted in
consideration of an application involving the expansion of a CON Authorized
Inpatient Provider, nor shall need be adjusted according to this rule in any
region wherein a CON Authorized freestanding Inpatient Hospice facility already
exists.
(e) Adjustments
The need for inpatient hospice beds, as determined by the methodology, is subject to adjustments by the SHCC. The SHCC may adjust the need for inpatient hospice beds in a region if an applicant documents the existence of at least one of the following conditions:
1. Absence of available inpatient beds for a
hospice certified for Medicaid and Medicare in the proposed region, and
evidence that the applicant will provide Medicaid and Medicare-certified
hospice services in the region; or
2. Absence of services by a hospice in the
proposed region that serves patients regardless of the patient's ability to
pay, and evidence that the applicant will provide services for patients
regardless of ability to pay.
3. A
community need for additional inpatient hospice services greater than those
supported by the numerical methodology.
(7) Inpatient Hospice Regions
The attached "Inpatient Hospice Regional County Listing" is hereby adopted as an Appendix "A" to Section 410-2-4-.15.
For a listing of Inpatient Hospice Facilities or the most current statistical need projections in Alabama contact the Data Division as follows:
|
MAILING ADDRESS (U. S. Postal Service) |
STREET ADDRESS (Commercial Carrier) |
|
PO BOX 303025 MONTGOMERY, AL 36130-3025 |
100 NORTH UNION STREET, SUITE 870 MONTGOMERY, AL 36104 |
|
TELEPHONE: (334) 242-4103 |
FAX: (334) 242-4113 |
EMAIL:
data.submit@ shpda.alabama.gov
WEBSITE:
Appendix A
Inpatient Hospice Regional County Listings
|
REGION 12 |
|||
|
REGION 1 |
REGION 9 |
||
|
Lee |
|||
|
Colbert |
REGION 5 |
Chambers |
Macon |
|
Franklin |
Clay |
Russell |
|
|
Lauderdale |
Jefferson |
Randolph |
|
|
Marion |
Talladega |
||
|
Tallapoosa |
REGION 13 |
||
|
REGION 6 |
|||
|
REGION 2 |
Baldwin |
||
|
Calhoun |
REGION 10 |
Mobile |
|
|
Jackson |
Cherokee |
Washington |
|
|
Limestone |
Cleburne |
Choctaw |
|
|
Madison |
Saint Clair |
Dallas |
|
|
Marengo |
REGION 14 |
||
|
Perry |
|||
|
REGION 3 |
REGION 7 |
Sumter |
Clarke |
|
Wilcox |
Conecuh |
||
|
Cullman |
Bibb |
Covington |
|
|
Lawrence |
Fayette |
Escambia |
|
|
Morgan |
Greene |
REGION 11 |
Monroe |
|
Walker |
Hale |
||
|
Winston |
Lamar |
Autauga |
|
|
Pickens |
Bullock |
REGION 15 |
|
|
Tuscaloosa |
Butler |
||
|
REGION 4 |
Crenshaw |
Barbour |
|
|
Elmore |
Coffee |
||
|
Blount |
REGION 8 |
Lowndes |
Dale |
|
DeKalb |
Montgomery |
Geneva |
|
|
Etowah |
Chilton |
Pike |
Henry |
|
Marshall |
Coosa |
Houston |
|
|
Shelby |
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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