Current through Register Vol. 24-18, September 15, 2024
The following rules apply to any in-home services agency
licensed or an applicant intending to become licensed to provide hospice
services, and intending to become a medicare certified or medicaid contracted
service provider in a designated planning area.
(1) The definitions in this subsection apply
throughout this section unless the context clearly indicates otherwise:
(a) "ADC" means average daily census and is
calculated by:
(i) Multiplying projected
annual hospice agency admissions by the most recent average length of stay in
Washington, based on the most recent data reported to the Centers for Medicare
and Medicaid Services (CMS) to derive the total annual days of care;
(ii) Dividing the total calculated in (a)(i)
of this subsection by three hundred sixty-five (days per year) to determine the
ADC.
(b) "Average length
of stay" means the average covered days of care per person for Washington state
as reported by CMS.
(c) "Base year"
means the most recent calendar year for which hospice survey data is available
as of September 30th of each year.
(d) "CMS" means the Centers for Medicare and
Medicaid Services.
(e) "Current
supply of hospice providers" means all providers of hospice services that have
received certificate of need approval to provide services within a planning
area. State licensed only and volunteer hospices are excluded from the current
supply of hospice providers.
(f)
"Hospice services" means symptom and pain management provided to a terminally
ill person, and emotional, spiritual and bereavement support for the terminally
ill person and family in a place of temporary or permanent residence provided
under the direction of an interdisciplinary team composed of at least a
registered nurse, social worker, physician, spiritual counselor, and a
volunteer.
(g) "OFM" means the
Washington state office of financial management.
(h) "Planning area" or "service area" means
an individual geographic area designated by the department for which hospice
need projections are calculated. For the purposes of hospice services, planning
area and service area have the same meaning.
(i) "Projection year" means the third
calendar year after the base year. For example, reviews using 2016 survey data
as the base year will use 2019 as the projection year.
(2) The department will review a hospice
application using the concurrent review cycle described in subsection (3) of
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 described in WAC
246-310-110(2)(c).
(3) Applications must be submitted and
reviewed according to Table A:
Table A
|
|
Application Submission
Period
|
Department Action
|
Application Review
Period
|
|
Concurrent Review Cycle
|
Letters of Intent Due
|
Receipt of Initial Application
|
End of Screening Period
|
Applicant Response
|
Beginning of Review
|
Public Comment
|
Rebuttal
|
Ex Parte Period
|
|
Cycle 1 (Chelan, Douglas, Clallam,
Clark, Skamania, Cowlitz, Grant, Grays Harbor, Island, Jefferson, King,
Kittitas, Klickitat, Okanogan, Pacific, San Juan, Skagit, Spokane, and
Yakima).
|
Last working day of November of each
year.
|
Last working day of December of each
year.
|
Last working day of January of each
year.
|
Last working day of February of each
year.
|
March 16 of each year or the first
working day thereafter.
|
45-Day public comment period (including
public hearing). Begins March 17 or the first working day
thereafter.
|
30-Day rebuttal period. Applicant and
affected person response to public comment.
|
75-Day ex parte period. Department
evaluation and decision.
|
|
Cycle 2 (Adams, Asotin, Benton,
Columbia, Ferry, Franklin, Garfield, Kitsap, Lewis, Lincoln, Mason, Pend
Oreille, Pierce, Snohomish, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom,
and Whitman).
|
Last working day of December of each
year.
|
Last working day of January of each
year.
|
Last working day of February of each
year.
|
Last working day of March of each
year.
|
April 16 of each year or the first
working day thereafter.
|
45-Day public comment period (including
public hearing). Begins April 17 or the first working day
thereafter.
|
30-Day rebuttal period. Applicant and
affected person response to public comment.
|
75-Day ex parte period. Department
evaluation and decision.
|
(4)
Pending certificate of need applications. A hospice service application
submitted prior to the effective date of these rules will be reviewed and
action taken based on the rules that were in effect on the date the application
was received.
(5) The department
will notify applicants fifteen calendar days prior to the scheduled decision
date if it is unable to meet the decision deadline on the application(s). In
that event, the department will establish and commit to a new decision
date.
(6) 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.
(7) Current hospice
capacity will be determined as follows:
(a)
For hospice agencies that have operated in a planning area for three years or
more, current hospice capacity is calculated by determining the average number
of unduplicated admissions for the last three years of operation;
(b) For hospice agencies that have operated
(or been approved to operate) in a 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 hospice agency as a
whole for the first three years to determine current hospice capacity. If a
hospice agency's reported admissions exceed an ADC of thirty-five, the
department will use the actual reported admissions to determine current hospice
capacity;
(c) For a hospice agency
that is no longer in operation, the department will use the historical
three-year admissions to calculate the statewide use rates, but will not use
the admissions to calculate planning area capacity;
(d) For a hospice agency that has changed
ownership, the department will use the historical three-year admissions to
calculate the statewide use rates, and will use the admissions to calculate
planning area capacity.
(8) Need projection. The following steps will
be used to project the need for hospice services.
(a) Step 1. Calculate the following two
statewide predicted hospice use rates using department of health survey and
vital statistics death data:
(i) The
percentage of patients age sixty-five and over who will use hospice services.
This percentage is calculated by dividing the average number of unduplicated
admissions over the last three years for patients sixty-five and over by the
average number of past three years statewide total deaths age sixty-five and
over.
(ii) The percentage of
patients under sixty-five who will use hospice services. This percentage is
calculated by dividing the average number of unduplicated admissions over the
last three years for patients under the age of sixty-five by the average number
of past three years statewide total deaths under sixty-five.
(b) Step 2. Calculate the average
number of total resident deaths over the last three years for each planning
area by age cohort.
(c) Step 3.
Multiply each hospice use rate determined in Step 1 by the planning areas
average total resident deaths determined in Step 2, separated by age
cohort.
(d) Step 4. Using the
projected patients calculated in Step 3, calculate a use rate by dividing
projected patients by the three-year historical average population by county.
Use this use rate to determine the potential volume of hospice use by the
projected population by the two age cohorts identified in Step 1, (a)(i) and
(ii) of this subsection using OFM data.
(e) Step 5. Combine the two age cohorts.
(i) Calculate the most recent three-year
average hospice capacity in each planning area using hospice agency admissions.
Subtract the calculated hospice capacity from the projected volumes calculated
in Step 4 to determine the number of projected admissions beyond the planning
area capacity.
(ii) For hospice
agencies qualified under subsection (7)(b) of this section, and whose recent
three-year average hospice capacity is below an ADC of 35, replace any reported
admissions with default admissions for each year over which the three-year
average is calculated.
(f) Step 6. Multiply the unmet need from Step
5 by the statewide average length of stay as determined by CMS to determine
unmet need patient days in the projection years.
(g) Step 7. Divide the unmet patient days
from Step 6 by 365 to determine the unmet need ADC.
(h) Step 8. Determine the number of hospice
agencies in the planning areas that could support the unmet need with an ADC of
thirty-five.
(9) If the
department becomes aware of a facility closure fifteen calendar days or more
prior to the letter of intent submission period, the department will update the
methodology for the application cycle. If a closure occurs fewer than fifteen
calendar days prior to the letter of intent submission period, the department
will not update the methodology until the next year.
(10) In addition to demonstrating numeric
need under subsection (7) of this section, applicants must meet the following
certificate of need requirements:
(a)
Determination of need under WAC
246-310-210;
(b) Determination of financial feasibility
under WAC
246-310-220;
(c) Criteria for structure and process of
care under WAC
246-310-230; and
(d) Determination of cost containment under
WAC 246-310-240.
(11) To conduct the superiority evaluation to
determine which competing applications to approve, the department will use only
the criteria and measures in this section to compare two or more applications
to each other.
(a) The following measures
must be used when comparing two or more applications to each other:
(i) Improved service to the planning
area;
(ii) Specific populations
including, but not limited to, pediatrics;
(iii) Minimum impact on existing
programs;
(iv) Greatest breadth and
depth of hospice services; and
(v)
Published and publicly available quality data.
(b) An application will be denied if it fails
to meet any criteria under WAC
246-310-210,
246-310-220,
246-310-230, or
246-310-240(2) or
(3).
(12) The department may grant a certificate
of need for a new hospice agency in a planning area where there is not numeric
need.
(a) The department will consider if the
applicant meets the following criteria:
(i)
All applicable review criteria and standards with the exception of numeric need
have been met;
(ii) The applicant
commits to serving medicare and medicaid patients; and
(iii) A specific population is underserved;
or
(iv) The population of the
county is low enough that the methodology has not projected need in five years,
and the population of the county is not sufficient to meet an ADC of
thirty-five.
(b) If more
than one applicant applies in a planning area, the department will give
preference to a hospice agency that proposes to be physically located within
the planning area.
(c) The
department has sole discretion to grant or deny application(s) submitted under
this subsection.
(13) Any
hospice agency granted a certificate of need for hospice services must provide
services to the entire county for which the certificate of need was
granted.
(14) Failure to operate
the hospice agency as approved in the certificate of need may be a basis for
revocation or suspension of a hospice 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.
