Governor Justice has asked the WV Health Care Authority to change the certificate of need formula as a way to promote more competition between hospices and to increase access for West Virginia residents.


Some think it should be higher as hospices are serving more patients, but raising the percentage of patients that a hospice must serve in a county from 25% to 49% of all deaths could hurt many West Virginia hospices, especially those in rural areas. Our greatest concern is that hospices in rural areas may close when they have fewer patients, great distances to travel, and narrow margins. Some rural counties may be left with no provider. Hospice is used a lot more in urban areas and that happens in other states too. The need formula must take that into consideration.


The percentage of patients served relative to all deaths should be lower to allow for several things. For example, there are patients who don’t want to give up their regular Medicare coverage to elect hospice and some prefer to go to their local hospital for care. Others are in VA hospitals or can’t have hospice if they are using their Medicare skilled nursing benefit. Those who are cared for by rural health clinics (or FQHC’s) may not be referred as their doctors can’t bill for the care of hospice patients. This is a problem in the Federal regulations that Senator Shelley Moore Capito is trying to fix with her sponsorship of the Rural Access to Hospice Act.


In addition to all these barriers to access, West Virginia has a high number of accidental deaths. These are patients that a hospice could never serve. In some counties, there are higher numbers of overdoses from opioids and in others more traffic accidents: these things should be considered.


Hospices are all working hard in their communities to promote referrals and encourage earlier access to hospice. We all agree that more patients in West Virginia could benefit from hospice care at the end of life. However, there are many reasons that hospice is not used more and more competition will not solve them.


Please help WV preserve the community-based hospices in our rural communities by reaching out to the Governor. Our communities have invested in their hospices by donating and volunteering and serving on their Boards. You can email him at or contact Chief of Staff, Mike Hall, by emailing his assistant