Procedure for Establishing a Hospice Agency


Purpose: This procedure describes the steps to become a licensed and certified hospice agency. Each site providing hospice services must be separately licensed. The North Carolina Medical Care Commission has rulemaking authority for hospice. The statutes that apply to hospice agencies are General Statute 131E-200 through 207 and the rules are under Title 10 of the North Carolina Administrative Code (10 NCAC 3T .0100 - .1000).

Please be aware that there may be variations in the process since individual projects may have special circumstances. The flow chart is intended to be a general guide to aid the applicant in completing the overall project.

Contacts: For questions regarding any part of this process, please contact the appropriate sections of the N.C. Division of Health Service Regulation:

Certificate of Need Section (919) 855-3873
Licensure; Acute and Home Care Branch (919) 733-1610
Medical Facilities Planning Section (919)855-3865


Procedure Summary:
In order to operate a hospice agency in North Carolina, an applicant first consults the State Medical Facilities Plan (SMFP) to determine if there is a projected need. If the SMFP does not indicate need for an additional agency, no certificate of need can be issued for a new hospice agency. If the SMFP indicates need for an additional hospice agency, the applicant must apply for a certificate of need. Applicants successfully obtaining a certificate of need must then apply for and obtain a license. Steps to obtain certification for Medicare and Medicaid are taken after the agency is licensed and in operation.

Procedures:

Step

Process followed
1.0 Consult the State Medical Facilities Plan: Medical Facilities Planning Section
1.1 Applicants can learn the number of hospice agencies needed in the annual State Medical Facilities Plan (SMFP), which is published for each calendar year and which specifies where in the state they are needed.
1.2 Applicants can also find the certificate of need review schedule and deadline for submittal of applications for these agencies, if there is a projected need, in the SMFP. No one may develop a new hospice agency without first obtaining a certificate of need. A certificate of need cannot be issued if the SMFP does not show a need for the hospice agency in the county where it is proposed.
2.0 Obtain a Certificate of Need: Certificate of Need Section
2.1 The applicant submits a certificate of need application for the proposed hospice agency according to the review schedule outlined in the SMFP.
2.2 The CON Section advertises a written public comment period and local public hearing. Within 30 days of the beginning of the review period, written comments may be filed by any person, including the applicant, regarding the proposals under review.
2.3 A public hearing is conducted by the CON Section within 30 to 50 days from the beginning of the review period, at which time the applicant is given the opportunity to respond to written comments submitted to the CON Section and inquiries made at the hearing.
2.4 A decision to approve or disapprove an application is made by the CON Section within 150 days of the beginning of the review period.
2.5 A certificate of need is issued 35 days after the date of approval if a petition for a contested case hearing is not filed.
2.6 After a certificate of need is issued, the applicant contacts the Acute and Home Care Branch about its requirements for the development of a hospice agency.
3.0 Obtain a license: Acute and Home Care Branch
3.1 The applicant requests a license application from the Branch. Since agencies may provide one or more home care services, a multi-purpose licensure application is used and a multi-program license may be issued (i.e., some facilities may be hospice only, while others may serve multiple purposes like home health and hospice). The applicant submits a completed application to the Branch.
3.2 The Branch reviews the application for completeness.
3.3 An initial on-site licensure survey is scheduled.
3.4 If the agency is in substantial compliance with the hospice licensure rules at the time of the on-site survey, a survey report is generated and a license is issued.
3.5 If the agency is not in substantial compliance with the hospice licensure rules, the applicant will be informed at the time of the on-site survey what additional information is needed to be in substantial compliance.
3.6 If there is a question of safety or adequacy of care, then the Branch attempts to assist the agency to reach compliance through consultations. If those efforts fail, licensure is denied.
4.0 Obtain certification: Acute and Home Care Branch
4.1 Agencies wishing to be certified for Medicare/Medicaid as a hospice agency must contact the Branch for a certification application packet.
4.2 The agency completes all required information returns it to the Branch.
4.3 As soon as the agency is ready for operation, it contacts the Branch to request an on-site survey.
4.4 If the packet has been approved by the Branch and by the agency’s fiscal intermediary, the Branch schedules the on-site survey, generally within three weeks of the request.
4.5 The Branch conducts the survey. If an agency has deficiencies during the initial survey, the effective date of certification will be the latest date a plan of correction is signed by the agency.
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This page last updated on February 02, 1999