small operations that exhibited troubling trends , including long average lengths of stay , high rates of non-terminal discharges and frequent instances of exceeding the aggregate cap — all indicators of potential fraud and abuse . To address these issues , the Centers for Medicare and Medicaid Services ( CMS ) has implemented enhanced oversight measures in states without the CON laws , including a full moratorium in California . These measures are a direct response to the risks posed by unchecked growth in the hospice sector .
But one does not have to look so far west to see that the hospice CON is important to protecting quality and access to care — simply look at our neighbors . According to the most recent data scores from the Consumer Assessment of Healthcare Providers and Systems ( CAHPS ), which measures the quality of care across eight quality measures , Kentucky and West Virginia , which both have hospice CON laws , rank number one and number four , respectively . Ohio , which does not have a CON for hospice ranks 41st in the nation . Additionally , if you look at the most recent CAHPS Hospice Star ratings , Kentucky and West Virginia rank number one and number three , respectively , while Ohio ranks 34th . Unsurprisingly , other non-CON states like California , Texas and New Mexico round out the bottom of the rankings .
While proponents of deregulating the hospice industry argue that competition drives improvement , evidence from states without the CON laws tells a different story . The rapid expansion of hospice providers in these states has often led to a decline in quality , with new entrants focusing on profit rather than patient-centered care . In fact , in December 2024 , CMS published its list of the 50 lowest performing hospices according to its Special Focus Program parameters . Of the 50 hospices on that list , 49 of them were from non-CON states . West Virginia ’ s exemplary quality ratings demonstrate that a controlled growth environment fosters better outcomes for patients and families .
One of the most critical benefits of West Virginia ’ s CON system is its role in protecting access to hospice care in rural communities . Currently , only 14 % of hospices nationwide operate in rural areas . This disparity is largely due to the preference of for-profit providers for urban markets , where shorter travel times and greater profit potential make operations more appealing . In West Virginia , existing hospice providers strategically use profits from urban areas to offset the financial challenges of serving rural patients . This cross-subsidization ensures no part of the state is left behind .
The CON is not designed to stifle growth . The review process allows for growth and expansion based on demonstrated need , ensuring that as population growth increases ,
What is the Certificate of Need ?
A Certificate of Need ( CON ) is a regulatory process used in many states to manage the quality of health care services . It requires health care providers , such as hospices , to demonstrate a clear and measurable need for their services in a specific area before they can establish or expand operations . The goal is to prevent the oversaturation of providers , which can dilute resources , destabilize existing services and compromise quality . By ensuring new facilities or programs are introduced based on actual community needs , the CON system promotes equitable access to care , safeguards rural and underserved areas and maintains high standards of service delivery . It also helps prevent wasteful spending and fosters a balanced health care ecosystem .
opportunities for more services and providers to enter the hospice space are provided . However , if new providers were to enter the market without demonstrating need , they would likely target only urban areas , leaving rural communities vulnerable and underserved . The loss of revenue from urban operations would jeopardize the ability of existing providers to maintain services in less profitable rural regions . For a state like West Virginia , where nearly 60 % of the population resides in rural areas , this could have devastating consequences for access to end-of-life care .
As policymakers and stakeholders consider the future of hospice care in West Virginia , protecting the CON for this unique health care service must remain a top priority . The state ’ s track record of excellence demonstrates that protecting the CON for hospice is the best way to ensure access and quality for all residents . Deregulating the hospice industry could open the door to the same challenges faced by states like California and Texas , where unchecked growth has led to fraud , abuse and declining care standards . In fact , the aforementioned moratorium in California has led to a migration of these fraudulent and low-quality hospice providers to other states with low barriers of entry and protections . In other words , the moratorium is not stopping the fraud ; the fraud is simply migrating to states unprotected by hospice CON laws .
Hospice is a unique health care benefit to which every West Virginian is entitled . Having hospice in your home can ease the pain and burden for patients and families at one of the most difficult times of their lives . West Virginians can be proud knowing the care they receive — no matter where they live in the state — is of the highest quality . The hospice CON is more than just a regulatory framework — it is a cornerstone of West Virginia ’ s commitment to quality , access and ethical care . By maintaining this system , the state can continue to lead the nation in hospice excellence while protecting its most underserved communities in their time of greatest need . In the face of growing pressure to deregulate , West Virginia must stand firm in its resolve to prioritize patients over profits . The future of hospice care in the Mountain State depends on it . •
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