STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

Transcription

1 STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number HPH South, Inc./CON # Majestic Boulevard Hudson, Florida Authorized Representative: Mr. Thomas Barb (727) LifePath Hospice, Inc./CON # Telecom Parkway, Suite 100 Temple Terrace, Florida Authorized Representative: Mr. H. Darrell White (813) Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida/CON # North Harwood, Suite 1500 Dallas, Texas Authorized Representative: Mr. Jason S. Howard (214) Service Area/Subdistrict Hospice Service Area 5B, Pinellas County B. PUBLIC HEARING A public hearing was not held or requested regarding the proposals to establish a hospice program in Hospice Service Area 5B. However, letters of support were submitted, as discussed below.

2 HPH South, Inc. (CON #10066) submitted approximately 257 letters of support with its application. These letters were from assisted living facilities, skilled nursing facilities, nursing homes, hospitals, home health agencies, local residents, local business owners, a congressman and HPH employees. The applicant s support letters from Pinellas County (Hospice Service Area 5B) are as follows: assisted living facilities, 23 nursing homes (Service Area 5B has 70 nursing homes), 15 businesses, nine physicians and eight residents. HPH has 10 letters of support from hospitals, six of which are located in Service Area 5B. The application also included 11 HPH employee letters of support. Approximately 160 of the applicant s letters are from supporters in Citrus, Hernando, Pasco and Hillsborough Counties. US Congressman, Gus M. Bilirakis, Ninth District Florida, lends his support to the applicant by stating, HPH Hospice is a great example of the steadfast commitment that non-profits provide to our community. HPH received a letter of support from Debra Howe, RN, NHA, President and CEO of Airamid Health Management which has 12 facilities in Pinellas County (11 skilled nursing and one assisted living). Ms. Howe indicated that Airamid Health Management and HPH have developed a plan for cooperatively working together in the Pinellas County service area. Airamid Health Management has agreed to execute a scatter bed contract with each of its 11 skilled nursing facilities so that HPH Hospice can immediately provide its patients needed hospice inpatient level of care. Airamid has also agreed to identify the number of beds HPH hospice would be able to utilize in its assisted living facility for a hospice residential unit. Airamid goes on to offer to lease HPH a 39-bed licensed skilled facility whenever the time comes that HPH would need an entire freestanding facility. Airamid describes HPH as an outstanding not-forprofit hospice provider who is on the cutting edge of hospice care. Chris Matchin, Administrator of Rehabilitation Center of St. Petersburg (a 159- bed nursing home) indicates they would be willing to lease space for a four or eight-bed inpatient unit depending on the needs of HPH. HPH also has letters of support from two area hospitals, Helen Ellis Memorial Hospital and Northside Hospital & Tampa Bay Heart Institute. Helen Ellis agrees to contract for inpatient services upon possession of CON. Northside expressed its interest in referring patients as appropriate. LifePath Hospice, Inc. (CON #10067) submitted 74 letters of support with its application. Nine letters were from Service Area 5B residents and three were from a Service Area 5B nursing home, assisted living facility and a long-term care facility. Twenty-six of the applicant s letters of support are from residents and businesses in Highlands, Polk, Hillsborough and Orange Counties. The other 36 letters were from families, friends and patients of LifePath Hospice expressing gratitude for services rendered. The three letters of support from Pinellas County health care facilities include Gulf Shore Rehabilitation and Nursing 2

3 Center, Grand Villa Assisted Living and Alzheimer s Residence and Pasadena Manor Long-Term Care Institute of St. Petersburg, Inc. These were form letters stating support for LifePath Hospice detailing the provider s success in delivering quality hospice care to the residents of Hillsborough County, its range of services and its operation of two hospice houses. These area providers support LifePath Hospice and assert their belief that it offers the widest range of services and the highest quality of care and would undoubtedly benefit the residents of Pinellas County. LifePath also has letters of support from HPC Pharmacy Services, Inc., HPC Staffing Services, Inc. and Axis Palliative Care, subsidiaries of its parent company HPC Healthcare, Inc. Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida (CON #10068) submitted 58 letters of support with its application. Odyssey s letters were signed and dated during May through June Sixteen of these letters were from Service Area 5B nursing homes, assisted living facilities, rehabilitation centers and a hospital. Jim Purcell, Florida Market President and Chief Executive Officer of Palms of Pasadena Hospital in St. Petersburg, Florida, expresses his concerns relative to a continuum of care and service matter in both Pinellas and Hillsborough Counties. He states that the level of service provided under the Suncoast delivery network is not considered exceptional. He goes on to state that patients, families and physicians complain consistently regarding the lack of support for the patients and their families. He urges the Agency to consider Odyssey as an option for services in Pinellas County. Olayinka Oyekoya, NHA, Administrator for South Heritage Health and Rehabilitation Center, St. Petersburg, Florida, states that often times, social service from hospice has little to no involvement, the nurse from hospice may only come to the facility once a week and South Heritage bears the responsibility for several areas of care that should come from the hospice provider that has admitted a Southern Heritage resident to their service. She asks that the Agency look favorably on the addition of a new hospice provider to Pinellas County. John Vunk, NHA, Administrator for Pasadena Manor, South Pasadena, Florida, states his facility has experienced vital concerns with the only hospice provider in Pinellas County. He lists the following concerns: Suncoast has failed to attend several of its routine care plan meetings which are regularly scheduled to discuss issues referring to patients living in its facility admitted to their care, and Suncoast removed a resident from the facility without permission. The patient passed away within a few hours of being taken from the facility; and uncooperative Suncoast staff which impedes the team approach to the care of the Manor s residents. Other letters discuss similar concerns and issues with Suncoast, which many (13 out of 16 facility letters) indicate can complicate care for the residents. It is noted that these facilities also note difficulty with timely 3

4 admissions to hospice and questionable practices of the existing hospice provider regarding appropriateness for hospice services. Thirty-four letter of support were from families who have received services from Odyssey-Daytona and Odyssey-Miami. The applicant provided seven memorandums of understanding all dated in 2007, with hospice providers in Service Area 5B to contract for inpatient beds. These memoranda were from Helen Ellis Memorial Hospital, Wright s Health Care and Rehabilitation Center, Pasadena Manor, Consulate Health Care of Safety Harbor, Baytree Rehabilitation and Nursing Center, East Bay Nursing Center and South Heritage Healthcare and Rehabilitation Center. C. PROJECT SUMMARY HPH South, Inc. (CON #10066) proposes the establishment of a new hospice program in Hospice Service Area 5B, Pinellas County. HPH is a newly formed not-for-profit corporation. It is a wholly owned subsidiary of Hernando-Pasco Hospice, Inc. HPH, Inc. has three existing hospice programs in Florida that are all single-county subdistricts: Citrus County, Hernando County, and Pasco County. The applicant states its parent company, HPH, has a history of being one of the oldest, nonprofit, successful hospices in Florida. The proposed total project cost is $327,188 with year one operating costs of $1,687,284and year two costs of $4,596,632. The applicant agrees to condition award of the CON as follows: 1. Quality of Care related conditions: Assess referred patients within two hours of referral, admitting as many as possible at that time (same day admission) with the target of greater than 50 percent that day and admit eligible patients within 48 hours of referral with the target of 75 percent within one day. Assist patients in obtaining physician referrals. Provide patients with ready access to HPH's Physician Group. Provide at a minimum the HPH average number of physician visits per admission in the Pinellas program, which far exceeds other providers' programs. For patients who self-report severe pain on admission, defined as level 7 or higher by the Florida DOEA, 95 percent will report that pain related to the terminal illness is reduced to 5 or below by the end of the 4th day of care in the Hospice program. This excludes patients that refuse to take pain medication or patients that have a separate pain reduction goal. 4

5 Attend death pronouncements in a patient's home. Accreditation: HPHS has conditioned approval of this application on the provision it will seek accreditation from either CHAP or JCAHO within 12 months of licensure. Extend HPH related organizations of pharmacy, durable medical equipment and home health into Pinellas County to enhance quality of services provided to Pinellas County residents. At a minimum, meet current national averages for staffing ratios. Initiate the Legacy Program for Pinellas County residents. Initiate the Compassionate Paws Program for Pinellas County residents. At a minimum, meet current national averages for staffing ratios. The above will be measured via submission to the Agency, a signed declaratory statement and documents evidencing the related activity including a copy of HPHS' accreditation certificate, admission reports evidencing assessment within two hours, assistance in obtaining physician referrals, staffing ratios, physician visit reports, interdisciplinary reports and other related documents. 2. Assisted Living Related Special Circumstances: Visit all Pinellas County assisted living facilities between date of licensure and date of certification to educate the ALF staff and residents about the availability and compatibility of hospice services in conjunction with their service programs. Implement the appropriate and targeted education plan for Assisted Living Facilities. The above will be measured via submission to the Agency, a signed declaratory statement and documents evidencing the related activity including trip reports of visits to all the assisted living facilities upon request. 3. Medically Complex Related Special Circumstances: Establish inpatient hospital and nursing home contracts within hospitals and nursing homes well dispersed throughout the subdistrict including each of those which provided related letters of support and others to be identified in the future. Minimum of three percent continuous care patient days by month 18 in the second year of operation and ongoing thereafter. 5

6 Develop an inpatient unit by month seven after licensure which will include capacity for both inpatient care and residential services. Treat hospice patients with psychiatric conditions, assuring admission criteria addresses these types of patients and physicians and interdisciplinary teams are equipped to manage their care. Establish a no charge policy for room and board for residential services to eliminate any financial barriers, assist homeless, AIDS patients and/or persons without caregivers to have 24- hour supportive services. The above will be measured via submission to the Agency, a signed declaratory statement and documents evidencing the related activity, including listing of hospital and nursing home contracts, patient day reports evidencing percent of patient days by level of service, location of inpatient unit and date of establishment of services and no charge policy for room and board. All of the above, and the forethought, analysis, research and commitment to the proposed HPH Pinellas County hospice as delineated throughout this application are why the applicant states, it should be allowed to mitigate the demonstrated Special and Not Normal circumstances, as well as respond to the fixed need pool. Hospice programs are required by federal and state law to provide services to everyone requesting them and therefore the Agency would not place conditions on a program to provide legally required services such as palliative radiation and chemotherapy and care to the indigent and charity patients. Rule 59C-1.013(4) Florida Administrative Code contains condition compliance reporting criteria that the Agency uses for an approved CON that has conditions. LifePath Hospice, Inc. (CON #10067) proposes the establishment of a new hospice program in Hospice Service Area 5B, Pinellas County. LifePath Hospice, Inc. is an existing not-for-profit hospice program servicing Hospice Service Area 6A (Hillsborough County). The applicant states it was licensed in 1983 to serve Hillsborough County and it is a community-based organization, established by community leaders. The applicant states it is responding to the initial fixed need pool in Service Area 5B for one additional hospice program, before the Agency revised the need projections based on information submitted by an existing Service Area 5B provider. LifePath Hospice, Inc. contends that the initial need determination was correct and states that they have filed corrective action seeking to reinstate the original fixed need pool. 6

7 The applicant is proposing total project costs of $302,012 with year one operating cost of $4,104,646 and year two costs of $9,338,583. The applicant has agreed to condition award of the CON upon providing the following: 1. LifePath Hospice commits to an expenditure of $250,000 per year for the first two years of operation in Pinellas County for community and patient programs and services not required or funded by the Medicare hospice benefit, as detailed in the conditions below. Measurement: LifePath Hospice will submit annual board meeting minutes documenting discussion and authorization of these expenditures. These minutes will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 2. LifePath Hospice commits to continued funding of these community and patient programs and services at the levels specified below, after the first two years, through fundraising, community support, and community reinvestment of excess revenue achieved through careful stewardship of financial resources. LifePath Hospice commits to ensure that all donations raised in Pinellas County will be used in Pinellas County. Measurement: LifePath Hospice will submit annual board meeting minutes documenting discussion and authorization of these expenditures. These minutes shall reflect the earmarking of any expenditures derived from Pinellas County donations for Pinellas County needs. These minutes will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. LifePath Hospice's Commitment to Quality Standards 3. LifePath Hospice commits to seek and maintain accreditation from the Joint Commission for its Pinellas County operations. Currently, LifePath Hospice's Hillsborough County operations are fully accredited by the Joint Commission. This means LifePath Hospice voluntarily submits to an extensive evaluation of its compliance with Joint Commission health care standards on a continuing basis. LifePath Hospice will extend this same level of concern for maintaining quality standards to its Pinellas County program. 7

8 Measurement: LifePath Hospice will submit documentation from the Joint Commission that demonstrates that body's accreditation of LifePath Hospice's Pinellas County operations. This documentation will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. LifePath Hospice's Commitments to Community Outreach 4. In the first year of operation, LifePath Hospice will develop a Nursing Home Advisory Committee, comprised of Pinellas County nursing home administrators, and hold at least one meeting. The purpose of the committee is to facilitate continuing hospice education for nursing home staff, strengthen LifePath Hospice community relationships with nursing home facilities and encourage feedback to better recognize nursing home needs and identify priorities of hospice patients residing in nursing homes. Measurement: LifePath Hospice will submit minutes of the meeting of the Pinellas County Nursing Home Advisory Committee. These minutes will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 5. In the first year of operation, LifePath Hospice will develop an Assisted Living Facility Advisory Committee, comprised of Pinellas County ALF administrators, and hold at least one meeting. The purpose of the committee is to facilitate continuing hospice education for ALF staff, strengthen LifePath Hospice community relations with ALFs and encourage feedback to better recognize ALF needs and identify priorities of hospice patients residing in ALFs. Measurement: LifePath Hospice will submit minutes of the meeting of the Pinellas County Assisted Living Facility Advisory Committee. These minutes will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 6. In the first year of operation, LifePath Hospice will develop a Physician Advisory Committee, comprised of Pinellas County physicians, and hold at least one meeting. The purpose of the committee is to strengthen relationships with area physicians, educate physicians on the functions of hospice care and encourage feedback to better identify physician needs, recognize common goals and foster a commitment of shared patient care. 8

9 Measurement: LifePath Hospice will submit minutes of the meeting of the Pinellas County Physician Advisory Committee. These minutes will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 7. LifePath Hospice commits to providing Clinical Pastoral Education (CPE) in Pinellas County. LifePath Hospice will offer two CPE units (10 week courses each) within the first two years. This would be open to all clergy in the community. Measurement: LifePath Hospice will provide copies of the advertisements for each of the two courses, the syllabi for each course, and lists of the names of the participants in each course. These materials will be included in either the first or second annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code, depending upon when the courses are held. If no CPE units are offered during the first year, LifePath Hospice will so state in the compliance report for that year. 8. LifePath Hospice will offer and provide clinical training for the hospice and palliative medicine fellowship program affiliated with the University of South Florida College of Medicine in Pinellas County during year one and year two of the program. This would likely increase the chances of a hospice and palliative medicine fellowship trained physician practice in Pinellas County upon completion of the fellowship program. Measurement: LifePath Hospice will submit a copy of the executed agreement with the USF College of Medicine in Pinellas County. This agreement will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. If no agreement has been executed, LifePath Hospice will submit documentation evidencing its good faith efforts to obtain one. 9. LifePath Hospice will expand its research program to include patients and/or their caregivers in the Pinellas County service area who wish to participate in research studies during the first two years of operation. This would allow patients and/or their caregivers to contribute to advancing the science of hospice and palliative medicine, provide increased enrollment in studies among a challenging patient population, and ultimately improve the care provided to other hospice patients and their caregivers in the future. 9

10 Measurement: LifePath Hospice will provide a copy of the research protocol(s) in place for its studies involving human participants. This protocol shall indicate that patients and/or caregivers in Pinellas County are to be included in the research program. In addition, any written reports stemming from the research undertaken, and involving Pinellas County participants, shall be provided. A copy of these documents will be included in either the first or second annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code, depending upon when the research program is expanded to include Pinellas residents. If no expansion to Pinellas County occurs during the first year, LifePath Hospice will so state in the compliance report for that year. 10. LifePath Hospice commits to obtaining office space in Pinellas County prior to the start of operations in Pinellas County. This office space will be the first step in following LifePath Hospice's precedent of serving the community with the use of multiple sites located throughout the county. Measurement: LifePath Hospice will submit a copy of the executed lease agreement for office space in Pinellas County. This agreement will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. LifePath Hospice's Commitments to Non-core Hospice Programs and Services 11. LifePath Hospice commits to making "caregiver services" available to ensure the safety and support of patients in their home in Pinellas County. The caregiver program helps people who have a fragile or part-time caregiver. The program matches eligible patients and families with trained caregivers to provide homemaking and personal care tasks to enable patients to live with increased safety and comfort in their own homes. Measurement: LifePath Hospice will submit copies of policies and procedures governing its caregiver program and an activity log documenting the number of patients served each year by the caregiver program. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 10

11 12. LifePath Hospice will open a Transitions Program in the Pinellas County service area during the first year of operation in Pinellas County. The Transitions Program will admit patients who no longer meet eligibility criteria for hospice care or do not desire hospice care. The Transitions Program provides primarily volunteer services to those with life limiting illnesses as well as accesses community resources and services that can be of benefit to the patient and/or family. This service would be provided at no charge. Measurement: LifePath Hospice will submit copies of policies and procedures governing its Transitions Program, copies of brochures and other printed materials publicizing the opening of the program in Pinellas County, and copies of records documenting the number and date of admissions to the program. These materials will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 13. Pediatric Programs: LifePath Hospice will apply to become a provider for the Partners in Care (PIC) Pediatric Palliative Care Program in Pinellas County during the first year of operation. The PIC Program is a partnership between Children's Medical Services Network and Hospice. If so approved, LifePath Hospice will provide such services in the year following such approval of the program. Measurement: LifePath Hospice will submit documentation of the filing of its application to become a provider for the Partners in Care (PIC) Pediatric Palliative Care Program in Pinellas County. This documentation will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. LifePath Hospice will partner with its sister organization, Axis Palliative Healthcare, to ensure that pediatric palliative care services are provided to children at All Children's Hospital in Pinellas County. This will not only increase the provision of pediatric palliative care to the community, but also allow for additional continuity of care for the pediatric hospice patients who reside in Hillsborough County and may be hospitalized in All Children's Hospital in Pinellas County. 11

12 Measurement: LifePath Hospice will submit a copy of the executed agreement between Axis Palliative Healthcare and All Children's Hospital covering the provision of pediatric palliative care services to children at All Children's Hospital in Pinellas County. In addition, LifePath Hospice will provide data indicating the annual number of pediatric patients served. This information will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. If no agreement has been executed, LifePath Hospice will submit documentation evidencing the good faith efforts of Axis Palliative Healthcare to obtain one. 14. LifePath Hospice commits to bring to Pinellas County HospiceHelp24, LifePath Hospice s specialized phone service that allows it to promptly address patients and families hospice care needs 24 hours-a-day, seven-days-a-week. HospiceHelp24 utilizes a dedicated phone line staffed by trained, experienced LifePath Hospice professionals, rather than employees at an off-site contracted phone service. HospiceHelp24 will provide assistance with urgent care needs, facilitate new patient referrals and admissions, and dispatch nurses, chaplains, social workers and equipment technicians to private homes, assisted living facilities, nursing homes and hospitals. Measurement: LifePath Hospice will submit a copy of the job description for the Hospice Liaison position, a copy of records documenting all new hires into that position category, and copies of minutes of a representative sample of an IDG meeting (with any protected health information de-identified). These materials will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 15. Specialized Hospice Teams: In the first year of operation, LifePath Hospice will have a Hospice Liaison(s) to coordinate the specialty teams and conduct service line Interdisciplinary Group (IDG) meetings specific to assisted living facilities, nursing homes and hospitals. As the census grows, individual specialty teams will be established for patients residing in assisted living facilities, nursing homes and hospitals, with continued service line meeting along with the hospice representative assigned to the facility. 12

13 Measurement: LifePath Hospice will submit a copy of the job description for the Hospice Liaison position, a copy of records documenting all new hires into that position category, and copies of minutes of a representative sample of an IDG meeting (with any protected health information de-identified). These materials will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. Hospital Team: LifePath Hospice will establish a specialized IDG for patients who are in a contracted hospital. The patients include those who are admitted to hospice while residing in a contracted hospital based on the patient s preference and medical condition. For patients who choose to remain in the hospital due to the condition of the patient and preferences of the family, LifePath Hospice IDG will ensure services and support are provided in the hospital such as assisting with extubation of patient from a ventilator. Measurement: LifePath Hospice will submit practice guidelines governing the establishment and functions of the specialized hospital IDG, and documentation of the annual number of Pinellas County patients served by the hospital IDG. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. Nursing Home Team: LifePath Hospice will establish a specialized for patients who reside in nursing homes and community care residential facilities (CCRCs) which are campuses composed of nursing homes, assisted living facilities and independent living. This specialized IDG enhances the coordination of care between LifePath Hospice, the nursing home/ccrc staff based on the rules and regulations of the nursing home. Measurement: LifePath Hospice will submit practice guidelines governing the establishment and functions of the specialized nursing home IDG, and documentation of the annual number of Pinellas County patients served by the nursing home IDG. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 13

14 Assisted Living Facility Team: LifePath Hospice will establish a specialized IDG for patients who reside in assisted living facilities (ALF). This specialized IDG enhances the coordination of care between LifePath Hospice, the ALF staff and the patient and families based on the licensure of the facility. Measurement: LifePath Hospice will submit practice guidelines governing the establishment and functions of the specialized IDG for ALF residents, and documentation of the annual number of Pinellas County ALF residents served by the IDG. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 16. LifePath Hospice will make available to Pinellas County its diseasespecific program to assist patients suffering with chronic obstructive pulmonary disease (COPD). The LifePath Hospice COPD program improves patients quality of life by providing immediate access to emergency breathing relief and additional care education. Patients received COPD-specific educational materials and medication kits for the home, including a nebulizer if needed. Patients also received professional support from clinical staff with specialized COPD training, including telephone hotline support and in-home visits. Measurement: LifePath Hospice will submit copies of policies and procedures governing its COPD program and documentation of the number of Pinellas County patients who receive services under this program on an annual basis. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 17. LifePath Hospice commits to seek and maintain accreditation from the National Institute for Jewish Hospice (NIJH) for its Pinellas County program. Currently, LifePath Hospice s Hillsborough County program is fully accredited by the NIJH. Established in 1985, the NIJH s goal is to educate healthcare providers nationwide about the many aspects of providing hospice care for Jewish Patients. Accreditation by NIJH requires that all staff and volunteers received specialized education regarding the unique end-of-life care needs of patients and their families of the Jewish tradition and faith. LifePath Hospice will extend this same level of concern for Jewish patients in Pinellas County. 14

15 Measurement: LifePath Hospice will submit documentation from NIJH that demonstrates that body s accreditation of LifePath Hospice s Pinellas County operations. This documentation will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 18. Palliative Care: LifePath Hospice will partner with its sister organization, Axis Palliative Healthcare, to ensure that palliative care physician and ARNP consultations are provided to those residents of Pinellas County who may not be eligible for hospice care or those who do not wish to receive hospice care. This service will take place in Pinellas County hospitals and nursing homes during the first two years of operation in this service area. The focus of care for these patients is on maximizing quality of life and relieving suffering for those being evaluated and treated in this program. Measurement: LifePath Hospice will submit a list of all hospitals and nursing homes that have entered into an agreement with Axis Palliative Healthcare governing the provision of palliative care physician and ARNP consultations to those residents of Pinellas County who may not be eligible for hospice care or do not wish to receive hospice care. In addition, LifePath Hospice will provide data indicating then annual number of physician and ARNP consultations pursuant to such agreements. These materials will be included in either the first or second annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code, depending upon when this service is initiated. If the service is not launched during the first year, LifePath Hospice will so state in the report for that year. If no agreements have been executed by the end of the second year, LifePath Hospice will submit documentation evidencing the good faith efforts of Axis Palliative Healthcare to obtain them. LifePath Hospice will retain the services of a part-time employed physician, 0.5 full-time equivalent in the first year of operation, and a part-time employed ARNP 0.5 FTE in the first year of operation through its sister organization, HPC Staffing Services. LifePath Hospice will increase the time of the physician to 0.75 FTE during the second year of operation, and will increase the time of the ARNP to 0.75 FTE during the second year of operation. 15

16 Measurement: LifePath will submit copies of records documenting the hiring of the part-time physician and the parttime ARNP. Data submitted during the second year of operation will document the increase of both positions to 0.75 FTE. This information will be included in the annual conditions compliance report. 19. Bereavement Programs: LifePath Hospice's Circle of Love Center for Grieving Children is a safe, loving place where families can help each other. LifePath Hospice commits to providing this program beginning in the first year of operation in Pinellas County. LifePath Hospice will also provide ongoing grief support groups for children ages 3 to 18 and their parents. Measurement: LifePath Hospice will submit copies of policies and procedures governing its Circle of Love Center program, copies of brochures and other printed materials publicizing the opening of the program in Pinellas County, and documentation of the annual number of grief support groups for children and their parents held in Pinellas County. These materials will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. LifePath Hospice commits to making available to residents of Pinellas County an annual Children's Grief Camp, starting in the first year of operations. This yearly weekend camp, for children ages 6 to 16, helps those who have lost a loved one share their feelings of loss with others. The camp experience combines healing with fun, letting children know that life still has a lot to offer. Measurement: LifePath Hospice will furnish copies of brochures and other printed materials publicizing its Children's Grief Camp in Pinellas County and data indicating the number of camp participants. This information will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. 16

17 LifePath Hospice commits to providing individual grief counseling sessions for survivors in the first quarter of operation, and grief group counseling will be available after the first quarter. Support group sessions are eight (8) weeks long and focus on coping with loss. At the completion of the eight (8) week group cycle, participants will be invited to attend a monthly "topic" focused drop-in support group for as long as desired throughout their grief process. Specialized grief groups will be held during the holiday season and are specific community needs, such as widow and widowers group, loss of children groups. Measurement: LifePath Hospice will submit documentation of the number of individual monthly and periodic group support group meetings provided in Pinellas County on an annual basis. The information presented will include enumeration of Pinellas County resident "survivors" served. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. Children/Family Grief Retreats: Family Retreat: LifePath Hospice commits to conducting a weekend family retreat, in year one of operations in Pinellas County, to provide grieving families a means to explore their grief process and heal as individuals and as a family. Measurement: LifePath Hospice will submit copies of brochures and other printed materials publicizing its weekend family retreats in Pinellas County, as well as documentation of the date and number of attendees at the retreat. These documents will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. Adult Retreat: LifePath Hospice's annual adult retreat is an opportunity for adults (18 and older) who have experienced the death of a loved one to come together and share in a day of relaxation, reflection and healing. LifePath Hospice commits to conducting this program in Pinellas County within one year of commencement of operations. 17

18 Measurement: LifePath Hospice will submit copies of brochures and other printed materials publicizing its annual Adult Retreat in Pinellas County, as well as documentation of the date and number of attendees at the retreat. These materials will be included in the annual conditions compliance report submitted to the Agency pursuant to Rule 59C (4), Florida Administrative Code. Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida (CON #10068) proposes to establish a new hospice program in Hospice Service Area 5B, Pinellas County. The applicant states that its sole shareholder and parent is Odyssey HealthCare Operating B, LP. The parent is stated to have 92 Medicarecertified hospice programs in 29 states Odyssey is licensed in Florida as Odyssey HealthCare of Marion County, Inc. and serves three hospice service areas: Service Area 11 (Miami-Dade and Monroe Counties), Service Area 4B (Volusia and Flagler Counties) and as of January 1, 2010 Service Area 3B (Marion County). 1 The applicant states it is submitting its application in direct response to the initial defined need published by the Agency as well as in response to the applicant-defined need for another program based on reasonable and realistic hospice market forecasts. The applicant is proposing total project costs of $604,245 with year one operating cost of $1,912,947 and year two costs of $3,023,801. The applicant proposed to condition the application based on the following: 1. The applicant will provide supportive hospice services, such as but not limited to: palliative radiation therapy and palliative chemotherapy related to the patient s terminal diagnosis. This will be measured via a signed declaratory statement by the applicant which may be supported via a review of patient medical records. 2. The applicant will provide continuous care. This will be measured via a signed declaratory statement by applicant which may be supported via a review of patient medical records. 3. The applicant will implement the "Care Beyond" Program. This will be measured via a signed declaratory statement by applicant. 1 Odyssey HealthCare of Marion County, Inc. became licensee for hospice Service Areas 4B & 11 effective November 1, 2009 and added Marion County to its license effective January 1, Odyssey had previously operated as Odyssey HealthCare. 18

19 4. The applicant will provide hospice services 24 hours a day, seven days a week including weekend care as indicated by the patient's medical condition. This will be measured via a signed declaratory statement by applicant which may be supported via a review of patient medical records. 5. The applicant will admit all eligible patients without regard to their ability to pay. This will be measured by the applicant's Medicare certification which requires this standard. 6. The applicant commits to having every patient being assessed by a physician upon admission to the hospice. This will be measured via a signed declaratory statement by the applicant which may be supported via a review of patient medical records. 7. The applicant will immediately implement its Performance Improvement (PI) plan including the following assessments: pain management, family satisfaction, employee satisfaction, and referral source satisfaction. This will be measured via a signed declaratory statement by the applicant which may be supported via a review of patient medical records. 8. The applicant will make available a range of non-covered supplementary therapies such as but not limited to: pet, music, massage, aroma and other holistic treatments. This will be measured via a signed declaratory statement by the applicant which may be supported via a review of patient medical records. 9. The applicant will implement Odyssey's triage and on-call programs upon licensure. These programs provide for uninterrupted 24-hour care seven days a week. Further explanation of the program is offered in the application narrative. This will be measured via a signed declaratory statement by the applicant. 10. The applicant will establish a local ethics committee within the first year of operation. This will be measured via submissions of the names and other relevant information of the Ethics Committee members and the related schedule of meetings to the Agency. 11. The applicant will establish a local medical advisory committee within the first year of operation. This will be measured via submissions of the names and other relevant information of the Medical Advisory Committee members and the related schedule of meetings to the Agency. 19

20 12. The applicant will provide educational programs, including but not limited to, in-service training (components of Odyssey University) resources to the community, including nursing homes, assisted living facilities, and the Council on Aging. In-service training would be offered to registered nurses, social workers, administrators and other staff that would benefit from an increased knowledge of hospice care and services. The applicant will host at least one seminar annually during the first two years of operation for clergy and community faith leaders (The Clergy End of Life Education Program), to enhance spiritual support for hospice patients in the district. This will be measured via a signed declaratory statement by the applicant. 13. The applicant will provide patients, family members and referral sources with information of services provided by the Dream Foundation. The Dream Foundation is the first national group of its kind that exists for terminally ill applicants over the age of 18. Through its Day Dreams (a program for terminally ill adults over the age of 65), Emergency Dreams and Quality of life Dreams, the Dream Foundation provides patients and families with a sense of completion and fulfillment. Odyssey has partnered with the Dream Foundation to improve care for our patients and to advance our mutual interests in the field of hospice. This will be measured via a signed declaratory statement by the applicant. 14. The applicant, through Odyssey HealthCare, Inc. or the Odyssey VistaCare Hospice Foundation, will make a $25,000 contribution to an appropriate not-for-profit entity in the community to fund education for end-of-life issues. Upon approval, Odyssey will meet with the Area Council on Aging or similar organizations to identify and determine the most appropriate entity within the community related to education for end-of-life issues. This will be measured via a signed declaratory statement by the applicant and evidence of funds provided to the not-for-profit entity. 15. The applicant will commit to 0.5 FTE the first year of operation to evaluate the need, if any, for an expanded children's hospice program in the community including, but not limited to, the need for a children's program that offers an expanded hospice benefit for patients up to age 21. The program would focus on longer term services for patients who may not otherwise qualify for hospice such as those with developmental conditions, cancers, chronic illnesses or brain injury that shorten lives and place special demands on families. If during the first year of operation it is determined that existing children's hospice services in the community are available to meet local needs, the applicant will donate $25,000 to support existing local children's hospice 20

21 programs. If after this first year there is found to be a need for additional children's hospice services, a CFSP (Child and Family Support Program) interdisciplinary team will be established to support the needs of this target population. This will be measured via a signed declaratory statement by the applicant. 16. The applicant will commit to 0.5 FTE the first year of operation for development efforts regarding community bereavement programs in the community. The bereavement programs will be broadly based to extend beyond the families of patients admitted to Odyssey HealthCare. These programs will be an extension of the programs currently offered in the Hospice Service area. The applicant will provide bilingual staff to provide bereavement services to the Hispanic population, including Hispanic children. At a minimum, one bereavement group consisting of approximately eight sessions will be offered by the end of the first year of operation. As the bereavement client census increases after one year, full-time staff will be employed. This will be measured via a signed declaratory statement by the applicant. 17. The applicant will commit to the provision of programs for the Hispanic and other minority populations which will include support from or involvement of bilingual staff, translated literature, training on cultural differences and competencies and flexible programming to meet their unique needs. Hospice staffing will reflect the racial and ethnic mix of the local community served. This will be measured via a signed declaratory statement by the applicant. 18. The applicant will develop a community resource library during the first year of the proposed hospice's operation. The library will include various lay and professional education pieces related to chronic illness, death, dying and bereavement. This will be measured via a signed declaratory statement by the applicant. 19. The applicant commits that the Odyssey VistaCare Hospice Foundation will facilitate the provision of a children's bereavement camp in Florida by the end of the first year of operation, similar to what Odyssey currently provides via Odyssey's SkyCamp, Camp Healing Tree and Camp Odyssey. This will be measured via a signed declaratory statement by the applicant. 20. The applicant will have a minimum staff of at least three community education representatives (CER), expanding community awareness of hospice services and educating local medical staff, community leaders and potential hospice patients as to the benefits of and availability of hospice care. Compliance with 21

22 this condition will be measured via submission of an annual report confirming that at least three CER staff members are employed at the proposed new service and active in the local community. Additionally, if approved, Odyssey will provide education, training and assistance in development of respite care policies, procedures and protocols to nursing homes. 21. The applicant commits to become accredited by the Joint Commission and the National Institute for Jewish Hospice by the end of its second year of operation. 22. The applicant commits to medical directors assessing every patient on admission and providing visits in home or place of residence. Medical director to be board-certified in hospice and palliative care medicine or will apply for board-certification within five years of employment. 23. The applicant commits that every patient will be contacted on a daily basis. 24. The applicant commits to sponsoring two to four education seminars per year for physicians, long term care facilities and ALFs. The focus of these seminars is to educate the local health care community on the provision of hospice services within ALFs and other long-term care facilities: a coordinated plan of care for the patient, increased support for patient, family and facility staff, and the provision of equipment, medication and supplies. ALL: None of the applicants proposed to condition to voluntary reporting of the Agency s Family Evaluation of Hospice Care (FEHC) Satisfaction Survey found at the FloridaHealthFinder.gov website. Hospice programs are required by federal and state law to provide services to everyone requesting them and therefore the Agency would not place conditions on a program to provide legally required services. Rule 59C-1.013(4) Florida Administrative Code contains condition compliance reporting criteria that the Agency uses for an approved CON that has conditions. D. REVIEW PROCEDURE The evaluation process is structured by the certificate of need review criteria found in Section , Florida Statutes, rules of the State of Florida, and Chapters 59C-1 and 59C-2, Florida Administrative Code. These criteria form the basis for the goals of the review process. The goals represent desirable outcomes to be attained by successful applicants who demonstrate an overall compliance with the criteria. 22