West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-17 - Health Services Offered By Health Professionals › Section 65-17-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule, all terms that are defined
				  in W. Va. Code §
									16-2D-1 et
				  seq. have those same meanings which are in some cases further clarified in this
				  rule. All terms not defined in W. Va. Code §
									16-2D-1 et
				  seq. have the following meanings unless the context expressly requires
				  otherwise.
2.1. "Diagnostic center"
				includes any facility or private office practice, free standing or attached to
				another building, stationary or mobile and means:
2.1.a. Any private office practice of one or
				more health professionals licensed, authorized, or organized pursuant to
				Chapter 30 of the West Virginia Code which offers laboratory or imaging
				services and in which the total cost of all the equipment required to provide
				these services exceeds $2,000,000; In determining whether the total cost of
				equipment exceeds $2,000,000, the cost of studies, surveys, designs, plans,
				working drawings, specifications, and other activities essential to the
				acquisition of the equipment shall be included; If the equipment is acquired
				for less than fair market value, the term "cost" includes fair market value;
				The term "cost" also includes a series of expenditures which exceeds $2,000,000
				if the State agency determines that the sum total constitutes a single
				expenditure subject to review under the provisions of the Health Care
				Authority's legislative rule, "Certificate of Need," 65 CSR 7, subdivision
				3.6.a., 3.6.b., and 3.6.c.;
2.1.b.
				Any facility owned or operated by one or more health professionals licensed,
				authorized, or organized pursuant to Chapter 30 of the West Virginia Code whose
				primary purpose is to offer laboratory or imaging services, including but not
				limited to the offering of the laboratory or imaging services through an entity
				which derives more than seventy-five percent (75%) of its gross revenues from
				such laboratory or imaging services, regardless of the cost associated with the
				proposal;
2.1.c. Any facility owned
				or operated by one or more health professionals licensed, authorized, or
				organized pursuant to Chapter 30 of the West Virginia Code which offers
				laboratory or imaging services to patients that are sent by other licensed
				health care professionals for the sole purpose of obtaining the laboratory or
				imaging services, regardless of the cost associated with the proposal. A
				facility shall not be deemed a diagnostic center under subsection 2.1.c. if the
				proportion of laboratory procedures performed on such patients does not exceed
				25% of the total laboratory procedures performed by the facility, and the
				proportion of imaging procedures performed on such patients does not exceed 25%
				of the total imaging procedures performed by the facility;
2.1.d. Any facility owned or operated by one
				or more health professionals licensed, authorized, or organized pursuant to
				Chapter 30 of the West Virginia Code which offers laboratory or imaging
				services to patients, and which is not organized as a sole practitioner, a
				partnership of licensed professionals, a professional limited liability company
				authorized by the appropriate licensing board pursuant to Chapter 30, or a
				professional corporation authorized by the appropriate licensing board pursuant
				to Chapter 30, regardless of the cost associated with the proposal;
2.1.e. Any facility owned or operated by one
				or more health professionals licensed, authorized, or organized pursuant to
				Chapter 30 of the West Virginia Code which offers laboratory or imaging
				services to patients through an entity for which any owner furnishes less than
				seventy-five percent (75%) of his or her total time spent on patient care
				services, regardless of the cost associated with the proposal; or
2.1.f. Any facility owned or operated by one
				or more health professionals licensed, authorized, or organized pursuant to
				Chapter 30 of the West Virginia Code which offers laboratory or imaging
				services to patients, and which facility is either licensed by the Office of
				Health Facility Licensure and Certification of the Department of Health and
				Human Resources, or accredited by the Joint Commission for the Accreditation of
				Healthcare Organizations, regardless of the cost associated with the proposal;
				provided however, that certification of a facility for any reason under Title
				42 of the United States Code, including but not limited to certification of a
				facility as a rural health clinic under the Medicare or Medicaid programs shall
				not result in a facility being classified as a diagnostic center.
2.1.g. Provided, that any private office
				practice currently offering one or more laboratory or imaging services,
				including but not limited to radiology, ultrasound, mammography, fluoroscopy,
				nuclear imaging, densitometry, or computerized tomography, shall not be deemed
				a diagnostic center if:
2.1.g.1. Such
				laboratory or imaging services were offered in a manner that did not constitute
				a diagnostic center under subsection 2.1 as it existed at the time such
				laboratory or imaging services were first offered;
2.1.g.2. Such laboratory or imaging services
				were offered in compliance with any certificate of need or ruling of
				non-reviewability received from the Health Care Authority; or
2.1.g.3. Such laboratory or imaging services
				were offered by the private office practice on the effective date of this rule;
				provided however, that the number of laboratory or imaging procedures performed
				on patients who are sent to the private office practice subsequent to the
				effective date of this rule for the sole purpose of obtaining laboratory or
				imaging services must remain at or below the level performed on such patients
				in 2006, or the level established by calculating an annual average based upon
				calendar years 2004 through 2006, inclusive.