West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-19 - Review For Automatic Rate Changes › Section 65-19-4 - Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
Any hospital which is licensed for one hundred (100) beds or
				  less and is not located in a standard metropolitan statistical area which wants
				  to change or amend any portion of its previously approved schedule of rates in
				  an amount equal to or less than the rate of inflation as published -by Data
				  Resources/McGraw Hill shall do so in accordance with this rule.
4.1. The hospital must file an application, a
				copy of the proposed budget approved by the hospital's board, and a copy of its
				license with the Authority at least five (5) days prior to the beginning of the
				hospital's fiscal year. The application shall be on a form to be provided by
				the Authority. A minimum of three hundred sixty-five (365) days shall have
				elapsed since the hospital placed into effect its last rate increase.
4.2. At least five (5) days prior to the
				beginning of its fiscal year and five (5) days prior to instituting the
				increase, the hospital must notify the Authority of its intention to implement
				the increase.
4.3. The hospital
				must inform the Authority of its inpatient utilization during the fiscal year
				prior to the date of the notice and the anticipated inpatient utilization for
				the fiscal year affected by the increase. The hospital shall also inform the
				Authority of the amount of gross inpatient revenue it received for the fiscal
				year prior to the increase and the amount of gross inpatient revenue it expects
				to receive during the fiscal year affected by the increase.
4.4. Within thirty (30) days after
				implementing the increase in its gross inpatient revenues per discharge for its
				non-governmental payors, the hospital shall file an amendment to its schedule
				of rates reflecting the effect of the increase.
4.5.
Rate of
				inflation
- The hospital shall determine the applicable rate of
				inflation for the hospital industry by referring to the most recent publication
				of Data Resources/McGraw Hill. The hospital may request the Authority to
				provide it with the current Data Resources Index (DRI) prior to filing the
				application required by subsection 4.1 of this rule. The DRI shall be
				applicable for sixty (60) days from the date of this letter from the Authority
				notifying the hospital of the figure. The rate of inflation shall not be
				adjusted for the increasing costs of technology, nonsupervisory wages,
				malpractice premiums, new services, or any other reason.
4.6. Within thirty (30) days of receiving the
				hospital's schedule of rates as required by subsection 4.4 of this rule, the
				Authority shall issue a decision approving or disapproving the increase put
				into effect by the hospital. The hospital may implement the rate increase
				during this thirty (30) day period. The Authority's evaluation will be limited
				to the rate of increase for gross inpatient revenues per discharge for
				non-governmental payors and will establish that the increase is equal to or
				less than the rate of inflation as established by the DRI. The decision shall
				be made upon the facts presented by the hospital and the records on file with
				the Authority, The decision is an appealable order.
4.7. Notwithstanding the provisions of
				subsection 4.6 of this rule, if the board subsequently determines that the
				increase put into effect by the hospital actually exceeded the rate approved by
				the Authority, for whatever reason, the Authority may institute a review and
				investigation of the hospital's rates and budget and take such action as it
				considers necessary to establish a new rate schedule and also direct a refund
				to the hospital's patients or a temporary decrease in the hospital's rates. The
				decision resulting from the review and investigation is appealable.
4.8. This section also applies to any
				hospital which seeks to increase or decrease its outpatient revenue or its
				nonpatient revenues from nongovernmental sources. In addition, if the hospital
				experiences less inpatient utilization for the twelve (12) months following the
				increase than it had anticipated when the automatic rate of inflation increase
				was obtained, the hospital's average rate per discharge shall not later be
				increased to compensate for the decline in gross inpatient revenue without
				permission of the Authority.
4.9.
				"Fop hospitals which have obtained an automatic rate of inflation increase, if
				the hospital actually experiences gross inpatient revenues per discharge for
				non-governmental payors in excess of the amount it was allowed, then the
				hospital is subject to ail of the penalties provided for by W. Va. Code, §
				16-293-1 et seq., including refunds and temporary rate decreases as provided
				for by W. Va. Code, §
									16-29B-21(d) and
				(e), and also the criminal provisions of W.
				Va. Code, §
									16-29B-27.
				Liability will be determined by reference to those sections and not by these
				rules.
4.10. While the automatic
				rate of inflation increase is calculated upon the actual average revenue per
				discharge for the hospital's past fiscal year, the Authority will continue to
				monitor the hospital's compliance with the Authority's prior orders. Should
				such monitoring reveal that the hospital exceeded its prior revenue limits,
				then the Authority will take corrective action against the hospital as a result
				of that excess and will also take corrective action against the rates being
				charged by the hospital after any automatic rate of inflation
				increase.