State approves applications for new hospice programs, rejects others

The Agency for Health Care Administration gave approval Monday to certificate of need applications for two new hospice programs and rejected applications for three others.

The decisions are tentative and can — and probably will — be challenged in state administrative court.

State regulators approved a Certificate of Need (CON) application submitted by Gulfside Hospice, Inc. to open a 24-bed inpatient hospice facility in Pasco County. Gulfside, which has been providing hospice services in the area for 32 years, anticipates it will finish construction on the 23,469 square foot building in December 2023 and will begin offering care on Jan. 1, 2024.

The new project is estimated to cost $13,066,020 according to a review of its CON application. More than half of those costs, or $7,890,400, are attributable to construction.

The project involves a total of 23,469 square feet of construction. Gulfside has not picked the location for the new building yet but said in the application it will be located in southwestern Pasco County, “near or in reasonable proximity” to three major hospitals: Morton Plant North Bay Hospital, HCA Florida Trinity Hospital and HCA Florida Bayonet Point.

The CON application submitted by Affinity Care of Charlotte and DeSoto, LLC for a new hospice program in Charlotte County, also received tentative approval. That application edged out two others that were submitted by vendors that also wanted to open a new hospice program in the county. 

Applications submitted by Florida Hospice, LLC and VITAS Healthcare Corporation of Florida were rejected in favor of the CON application submitted by Affinity Care.

The existing hospice provider in the county, Empath Tidewell, Inc., was opposed to all three CON applications for new services in the area, noting the agency did not publish a need for an additional hospice in the area.

Indeed, the state did not publish a need for any additional hospice programs in the latest batching cycle.

The AHCA analysis of the three CON applications notes that Empath Tidewell specifically stated that if the state gave approval to VITAS or Florida Hospice, “increased quality hospice services to residents of Charlotte and DeSoto Counties” would not be provided. 

Moreover, it argued that Affinity, which has three Florida-licensed hospice affiliates — Continuum Care of Sarasota, LLC, Continuum Care of Broward, LLC, and Continuum Care of Miami-Dade, LLC — does not have a history of reporting Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. 

The scores were developed with the purpose of supporting investigator-led research to better understand patient experience and to use the results to improve the quality of care. Given that the CAHPS scores aren’t reported by Affinity, Empath Tidwell argued that it also is “unreasonable to assume that approval of Affinity would offer increased quality services“ to the area residents.

Hospice care is provided to people who are nearing the end of life. The goal is to maximize comfort and ease treatment for underlying medical conditions causing death. Hospice services are provided by a team of health care professionals led by a physician. Medicare, Medicaid and commercial health insurance provide coverage for hospice care.

While the state eliminated CONs for hospitals, it still relies on the licensure program for the regulation of hospice, nursing homes and intermediate care facilities for the developmentally disabled.

For planning purposes, AHCA divides the state into 11 regions and determines whether there is additional need for the regulated service in each region. After the fixed need is published, interested entities are required to file what is known as a letter of intent. The letters are not binding but must be submitted by all entities interested in providing the services. The letter of intent is followed by an official application. The applications are competitively reviewed against one another by health care regulators.

Meanwhile, the state also denied a CON application submitted by Seasons Hospice & Palliative Care of Palm Beach County, LLC to open a new hospice program in the county. The estimated cost is $859,721 and includes building, equipment, development and start-up costs.