West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-05 - Hospital Cost-Based Rate Review System › Section 65-5-9 - Expedited Review

Current through Register Vol. XLI, No. 28, July 12, 2024
Any hospital which is licensed for more than one hundred
				  (100) beds or that is located in a Standard Metropolitan Statistical Area which
				  intends to revise any of its previously approved revenue limits in an amount
				  equal to or less than the inflation factor approved by the Authority may do so
				  in accordance with this rule if the hospital has previously implemented revenue
				  limits approved by the Authority pursuant to the cost based rate system.
9.1. The hospital shall file an application
				with the Authority at least forty-five (45) days prior to the beginning of its
				fiscal year on forms to be provided by the Authority. The hospital shall submit
				with its application a copy of its current license issued pursuant to W. Va.
				Code '16-5B-1
				et seq. The hospital shall also submit with its application a copy of the
				budget approved by the hospital's board for the fiscal year affected by the
				increase. The budget must contain all usual information under generally
				accepted accounting principles for a budget and a full and specific statement
				of all assumptions relied upon in preparing the budget. In the event the
				hospital intends to obtain approval of any discount contract pursuant to W. Va.
				Code '16-29B-20, the
				hospital shall also file with the Authority all of the information requested on
				forms provided by the Authority, which shall include an explanation of the
				requirements set forth in W. Va. Code '16-29B-20; the
				hospital shall also file a summary of the basic terms of the contract a copy of
				the proposed discount contract; and, any other information required by the
				Authority. The Authority shall approve or deny the proposed discount contract
				within the one hundred eighty (180) day time period for review of rate
				applications set forth in subsection 6.5 of this rule. All information
				contained in the proposed discount contract or related thereto shall be subject
				to public disclosure as a public record. The provisions of this rule for
				consideration of discount contracts in the rate review process shall supplement
				the provisions for retroactive review of discount contracts for certain border
				hospitals pursuant to C.S.R. '65-22-1, et seq., insofar as such provisions
				relate to such retroactive review of discount contracts for border hospitals
				previously temporarily approved under C.S.R. '65-22-1, et seq., and otherwise
				the provisions under C.S.R. '65-22-1, et seq., regarding temporary approval of
				discount contracts for certain border hospitals shall apply to the temporary
				approval thereof. The application shall include a certification by the chief
				executive officer and the chairman of the board of the hospital that the
				information contained therein is true and accurate.
9.2. Eligibility standards - Upon receipt of
				the application, license and budget, the Authority shall determine:
(1) if the hospital, in its current fiscal
				year, has provided charity care equal to or greater than the most recent state
				average as published by the Authority. Charity care shall be determined in
				accordance with the guidelines contained in this rule and shall not include bad
				debt; and
(2) if the hospital is in
				compliance with its approved revenue limits in all of these categories:
(a) gross inpatient revenue per day,
(b) gross inpatient revenue per
				discharge,
(c) gross inpatient
				acute care revenue,
(d) outpatient
				revenue per visit,
(e) gross
				outpatient revenue; and
(f)
				individual revenue limits for distinct part units.
If the Authority determines the hospital has met these
				  requirements the hospital is eligible to request an expedited rate increase
				  pursuant to this section. If the hospital fails to meet these requirements, the
				  hospital shall not request a rate increase pursuant to this section.