The Uncertain Future of Hospice Certificates of Need

Hospice News / By Holly Vessel

While their merits are hotly debated, the substance of certificate of need laws often exist in a state of flux.

Certificate of need (CON) laws have a huge influence on hospices’ ability to expand patients’ access to care, as well as impact the competitive landscape and quality of care in a given market.  

A myriad of factors play into states’ decisions to keep these laws on the books, according to Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization (NHPCO). 

“It really depends on the current culture of the state,” Lund Person told Hospice News. “It’s the atmosphere, beliefs about free-market economy and all those bigger things that play a role in whether a state even remotely considers a CON or not.”

As of December, 35 states and the District of Columbia had some type of CON program in place, reported the National Conference of State Legislatures (NCSL).

Wide variation exists in these laws from state to state in terms of requirements and applicability. Currently, 14 states have CON laws that include hospices.

Though New York enacted the first of these laws in 1964, they began to pick up steam due to federal requirements implemented during the 1970s. These federal rules were eventually repealed, and since then states have been left to make up their own minds about CON.

Will CON laws last?

To date, 12 states have rescinded their CON laws or allowed them to expire, according to NCSL. New Hampshire, which scrapped CON in 2016, was the most recent.

According to some, the prevalence of these laws may continue to dwindle.

“In this day and age, we’ll see how long CONs last,” Freeman Smith, north region president for Traditions Health told Hospice News at the VALUE Conference in Chicago. “There’s a real push to get rid of the CON state. It was a process to control the cost 20 years ago, but right now the market place determines that.”

Regulators and legislators in at least 18 states began reassessing their CON laws during the past three years.

Lawmakers introduced bills to remove all or most CON requirements in Alabama, Alaska, Kentucky, Maine, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina and West Virginia.

Several states also enacted or considered CON reform bills, some of which removed requirements for certain settings, including Michigan, Tennessee, Washington, Montana and Virginia. Montana removed CONs for all settings except nursing homes as of last October.

Additionally, three states — Connecticut, Delaware and Massachusetts —appointed commissions to study the issue…

Read Full Article