reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				interpretive rule is intended to provide guidance to certain free-standing,
				speciality hospitals that, in the agency's opinion, are subject either to the
				requirements of the Health Care Facility Financial Disclosure Act, W. Va. Code
				'16-5F-1, et seq., or
				of the West Virginia Health Care Cost Review Authority Act, W. Va. Code
				'16-29B-1
				et seq., or both. Pursuant to W. Va. Code '16-29B-10, and
				'16-29B-16(a), both of those Acts are administered by the board of the Health
				Care Cost Review Authority, W. Va. Code '16-29B-5.
1.2. Authority. -- W. Va. Code ''16-29B-8,
				17, 18, and 23, and 16-5F-3(a).
1.3. Filing Date. -- June 28, 1988.
1.4. Effective Date. -- July 28,
				1988.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The term
				"Authority" refers to the agency known as the West Virginia Health Care Cost
				Review Authority created by W. Va. Code '16-29B-5.
2.2. The term "board" refers to the three (3)
				member board which is charged with carrying out the duties imposed upon the
				Authority. W. Va. Code '16-29B-5(a).
2.3. The term "free-standing" as applied to a
				hospital or other inpatient facility means a physical structure which is
				physically independent from other inpatient facilities or an inpatient facility
				which is administered and managed separately from other inpatient facilities,
				or both.
2.4. The term "psychiatric
				hospital" means an acute-care institution which primarily provides to
				inpatients, by or under the supervision of a physician, specialized services
				for the diagnosis, treatment and rehabilitation of mentally ill and emotionally
				disturbed persons.
2.5. The term
				"rehabilitation hospital" means an inpatient facility which is operated for the
				primary purpose of assisting in the rehabilitation of disabled persons through
				an integrated program of medical and other services which are provided under
				competent professional supervision.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-3 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
The board administers several different statutory programs.
				  Two of those programs are involved in this interpretive rule. First, the West
				  Virginia Health Care Cost Review Authority Act, W. Va. Code '16-29B-1
				  et seq., provides for a uniform system of accounts and financial reporting
				  (section 17), for an annual financial reporting (section 18), and for a
				  utilization review and quality assurance program (section 23). Second, the West
				  Virginia Health Care Facility Financial Disclosure Act, W. Va. Code
				  '16-5F-1 et seq.,
				  requires the annual publication and filing of certain financial reports as well
				  as permitting the board to develop other requirements. The purpose of this
				  interpretive rule is to express the board's interpretation of these provisions
				  regarding free-standing acute-care psychiatric hospitals and free standing
				  rehabilitation hospitals.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-4 - Utilization Review And Quality Assurance

Current through Register Vol. XLI, No. 28, July 12, 2024
By a legislative rule titled "Legislative Rules To Implement
				  Utilization Review and Quality Assurance Program -Phase 1," 65 CSR 4 (1985),
				  the board has adopted a program of patient data submission from West Virginia
				  hospitals to the Authority. It is the opinion of the board that free-standing
				  acute-care psychiatric hospitals are subject to the provisions of that
				  legislative rule.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-5 - Annual Financial Reporting System

Current through Register Vol. XLI, No. 28, July 12, 2024
The board has implemented the provisions of section 17 and 18
				  of the Health Care Cost Review Authority Act, '16-29B-1 et seq., by adopting a
				  "Uniform Reporting System and Annual Wage and Salary Survey." That system was
				  exempt from the rule-making requirements of the Administrative Procedures Act,
				  W. Va. Code '29A-3-1
				  et seq. See W. Va. Code '16-29B-17(a).
				  It is the opinion of the board that free-standing acute-care psychiatric
				  hospitals are subject to the provisions of that system.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-6 - Health Care Facility Financial Disclosure

Current through Register Vol. XLI, No. 28, July 12, 2024
The board, pursuant to W. Va. Code '16-29B-16(a),
				  replaced the director of the department of health as the administrator of the
				  West Virginia Health Care Facility Financial Disclosure Act, W. Va. Code
				  '16-5F-1 et seq. That
				  Act requires "covered facilities" to publish and file certain financial reports
				  and documents on an annual basis. It is the opinion of the board that
				  free-standing acute-care psychiatric and free-standing rehabilitation hospitals
				  are subject to the provisions of that Act.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-7 - Rate Review Act

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Nothing in
				this interpretive rule is intended to change the policy of the board as
				expressed in the "Procedural Rule For Requests For Hospital Rate Changes," 65
				CSR 3 (1987), that presently excludes free-standing acute-care psychiatric
				hospitals from the requirements of the rate review and rate setting programs of
				W. Va. Code '16-29B-1
				et seq. If that policy is subsequently changed in a later phase of the rate
				review and rate setting programs, rules incorporating those changes will then
				be issued.
7.2. It is the present
				position of the board that it will not attempt to apply the provisions of the
				rate setting act, W. Va. Code '16-29B-1
				et seq., to free-standing rehabilitation hospitals. If after further study the
				inclusion of free-standing rehabilitation hospitals appears to be appropriate,
				then the board will engage in rule making to that effect. This present
				exclusion of such hospitals is not a waiver of the board's jurisdiction to make
				such a later change.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-12 - Coverage Of Financial Disclosure Acts And Utilization Review Requirements › Section 65-12-8 - Discrete Part Units

Current through Register Vol. XLI, No. 28, July 12, 2024
It is the opinion of the board that if an acute-care,
				  inpatient facility (that is, a hospital) has, among its other services, either
				  a discrete part psychiatric unit or a discrete part rehabilitation unit, or
				  both, those units as part of an otherwise covered hospital are subject to all
				  of the publication and reporting requirements discussed in section 4, 5, and 6
				  of this interpretive rule and are also subject to the requirements of the rate
				  review and rate setting programs; i.e., such units must be included by the
				  hospital in its submissions to the rate review and rate setting
				  programs.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This legislative rule
				implements the provisions of the financial reporting requirements of W. Va.
				Code §
									16-29B-1
et seq.
1.2. Authority. -- W. Va. Code
				§
									16-29B-8(b) and §
									16-29B-24.
1.3. Filing Date. -- March 30,
				2023.
1.4. Effective Date. -- April
				1, 2023.
1.5. This rule shall
				terminate and have no further force or effect on August 1, 2028.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The defined terms in W. Va. Code
				§
									16-29B-3 are incorporated by reference.
2.2. The following terms are defined:
2.2.a. "Annual financial report" means a
				complete audited financial statement for the preceding fiscal year, including
				all notes, schedules, and documents, prepared, and presented by an independent
				accountant or the auditor.
2.2.b.
				"Home health agency" means an organization primarily engaged in providing
				professional nursing services either directly or through contract arrangements
				and at least one of the following services:
2.2.b.1. Home health aide services;
2.2.b.2. Physical therapy;
2.2.b.3. Speech therapy;
2.2.b.4. Occupational therapy;
2.2.b.5. Nutritional services; or
2.2.b.6. Medical social services to persons
				in their place of residence on a part-time or intermittent basis.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-3 - Reports to be Filed with Authority

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Annually
				and within 120 days after the end of its fiscal year, unless an extension be
				granted by the authority, a covered facility shall file with the authority its
				annual financial report prepared by an accountant or auditor. If an audited
				financial report is not prepared by a covered facility or related organization,
				then that facility or organization shall provide the authority:
3.1.b. A statement of income;
3.1.c. A statement of changes in retained
				earnings;
3.1.d. A statement of
				cash flows;
3.1.e. A balance sheet
				for the reporting period; and
3.1.f. Other statement as required by
				generally accepted accounting principles.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-4 - Additional Information

Current through Register Vol. XLI, No. 28, July 12, 2024
The authority may request additional information to verify
				  the accuracy of the information submitted pursuant to this
				  rule.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-5 - Public Access to Information

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The
				information submitted pursuant to this rule is subject to the provisions of the
				Freedom of Information Act provided in Chapter 29B of the West Virginia
				Code.
5.2. Uniform Bill data is
				confidential. The authority may, however, release statistical data or reports
				based upon the Uniform Bill data subject to the signing of a data use
				agreement,
5.3. The authority may
				not charge a fee to a covered entity which submits information to obtain data
				submitted pursuant to this rule from the authority.
5.4. The authority shall publish the results
				of the home health utilization survey on the authority's web page at
http://www.hca.wv.gov
.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-6 - Administrative Penalty

Current through Register Vol. XLI, No. 28, July 12, 2024
The authority shall notify a covered facility or related
				  organization that fails to submit to the authority any information required by
				  this rule by certified mail, return receipt requested. If the failure continues
				  for more than 10 days after receipt of the notice, the delinquent facility or
				  organization is subject to a penalty of $1,000.00 for each day thereafter that
				  the failure continues. The authority shall pay any penalty received or
				  recovered into the state treasury to the account of the general
				  fund.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-13 - Financial Disclosure Rule › Section 65-13-7 - Exemption

Current through Register Vol. XLI, No. 28, July 12, 2024
The provisions of this rule do not apply to the legally
				  authorized practice of medicine by any one or more persons in the private
				  office of any health care provider.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-14 - Expedited Review For Rate Changes › Section 64-14-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope - This
				legislative rule establishes an expedited review process for hospitals licensed
				for more than one hundred (100) beds or that are located in a Standard
				Metropolitan Statistical Area for rate increase requests as provided by the
				1989 amendments to W. Va. Code
				16-29B-20(k).
1.2. Authority - W. Va. Code
				16-29B-20(k).
1.3. Filing Date -_______________.
1.4. Effective Date - .
				___________.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-14 - Expedited Review For Rate Changes › Section 64-14-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This legislative rule implements certain of the provisions of
				  Enrolled Committee Substitute for Committee Substitute for Senate Bill 576
				  which became effective on April 8, 1989, and was signed by the Governor. That
				  bill amended W. Va. Code
				  16-29B-20
				  by adding a new subsection. This new subsection (k) authorizes the Authority to
				  promulgate rules to develop an expedited review process for rate increase
				  requests from hospitals licensed for more than one hundred (100) beds or that
				  are located in a Standard Metropolitan Statistical Area.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-14 - Expedited Review For Rate Changes › Section 65-14-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, all terms have the same meaning as
				  provided in the definition section of the Health Care Cost Review Authority
				  Act, West Virginia Code, section three, article twenty-nine-b, chapter sixteen.
				  Definitions of additional terms are set forth below and whenever those terms
				  are used, the following definitions apply, except where the context may
				  expressly otherwise require.
3.1.
				"Authority" means the West Virginia Health Care Cost Review
				Authority.
3.2. "DRI'' refers to
				the inflation index for the hospital industry published by Data
				Resources/McGraw-Hill.
3.3. "Gross
				Revenue" means a hospital's gross patient revenue plus all operating and
				nonoperating revenues from whatever source.
3.4. - "Hospital" means:
3.4.1. A facility subject to licensure as
				such under the provisions of West Virginia Code, article five-b, chapter
				sixteen; or
3.4.2. Any acute care
				facility operated by the state government which is primarily engaged in
				providing to inpatients, by or under the supervision of physicians, diagnostic
				and therapeutic services for medical diagnosis, treatment and care of injured,
				disabled or sick persons; but, does not include state owned or operated mental
				health facilities, state owned or operated long-term care facilities, or
				speciality hospitals such as acute care psychiatric and rehabilitation
				hospitals.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes an exemption from certificate of need review the conversion of
				acute care beds to skilled nursing care beds by a licensed hospital as provided
				by W. Va. Code '16-2D-4a.
1.2. Authority. -- W. Va. Code '16-2D-4a;
				'16-2D-6.
1.3. Filing Date. --
				April 5, 1990.
1.4. Effective Date.
				-- April 5, 1990.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule implements Enrolled Committee Substitute for H. B.
				  2612 which was signed by the Governor. That bill created a new code section, W.
				  Va. Code '16-2D-4a. This new
				  section authorizes the Health Care Cost Review Authority to promulgate rules to
				  exempt from certificate of need review the conversion of acute care beds to
				  skilled nursing care beds by a licensed hospital under certain
				  conditions.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Acute-care bed
				complement - The number of licensed hospitals beds designated for acute care
				services exclusive of SNF and/or ICF long-term care beds and personal care
				beds.
3.2. Licensed bed capacity -
				The total number of hospital beds currently authorized for a hospital to
				operate by the department of health and human resources.
3.3. Skilled nursing bed - A long-term care
				bed desginated as an SNF (skilled nursing facility bed) and certified as such
				under Medicare Title XVIII reimbursement.
3.4. Intermediate care bed - A long-term care
				bed designated as an ICF (intermediate care bed) and certified as such under
				Medicaid Title XIX reimbursement.
3.5. Dually certified bed - A long-term care
				bed designated for use as both ICF and SNF and certified as such under Medicare
				and Medicaid reimbursement.
3.6.
				Verified notice - A notice containing the information required by this rule
				which has attached to it a statement made under oath by the chief executive
				officer of the hospital before a notary public or other official entitled to
				administer oaths that the facts and circumstances set forth in the notice are
				true or believed to be true by the chief executive officer.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-4 - Exemption criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A
				hospital licensed by the department of health and human resources otherwise
				subject to certificate of need review may obtain an exemption from review for
				the conversion of acute care beds to skilled nursing care beds if the hospital
				meets the following conditions:
a. It is
				located in a non-metropolitan statistical area as defined by the bureau of the
				census of the federal government;
b. It has experienced an average occupancy
				rate of less than fifty (50) percent for the twelve (12) months preceding the
				date of request for this exemption; and
c. The nursing home service area within which
				the hospital is located is under the bed ceiling as calculated by the thirty
				(30) beds per thousand population formula as set forth in the long-term care
				chapter of the state health plan, except for the purposes of this rule existing
				nursing home beds shall be used in the calculation. In determining eligibility
				pursuant to this requirement, the Health Care Cost Review Authority will
				determine if the existing nursing home bed supply within the nursing home
				service area in which the hospital is located exceeds the five-year projected
				nursing home bed ceiling for that service area. Only licensed beds shall be
				counted in the nursing home bed supply.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-5 - Verified notice, filing fee and review period

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. To request an exemption pursuant to this
				rule, the hospital must file a verified notice and the current filing fee
				applicable to exemption requests pursuant to 65 CSR 10, section 4.1 with the
				Health Care Cost Review Authority. The verified notice shall include the
				following information:
a. A copy of the
				current hospital license issued by the department of health and human
				resources;
b. A description of the
				number and type of acute care beds to be converted to skilled nursing beds; and
c.A compilation of the number of
				acute care patient days for each of the twelve (12) months preceding the date
				of request for this exemption.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-15 - Exemption For Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-15-6 - Substantial compliance review

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The hospital shall undergo substantial
				compliance review of the conversion to skilled nursing beds and submit a
				progress report to the Health Care Cost Review Authority no later than thirty
				(30) days after the initiation of the service. The following items shall be
				provided as part of the progress report for substantial compliance review:
1. Report of capital expenditures associated
				with the conversion;
2.
				Documentation of effective SNF certification date from the department of health
				and human resources; and
3.
				Documentation of the licensure and SNF certification approval from the
				department of health and human resources.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-16 - Exemption For Shared Services › Section 65-16-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislation rule establishes an exemption from certificate of need review for
				certain shared services between two (2) or more acute care facilities when the
				shared services can reasonably be mobile as provided by W. Va. Code
				'16-2D-4(f).
				This rule further repeals section five (5) of "Exemptions from Certificate of
				Need Review," '65 C.S.R. 11 (1988).
1.2. Authority. -- W. Va. Code '16-2D-4(f)
				and '16-2D-8.
1.3. Filing Date. --
				April 10, 1992.
1.4. Effective
				Date. -- April 10, 1992.
1.5. This
				legislative rule repeals and replaces section five (5) of the "Exemptions from
				Certificate of Need Review," '65 C.S.R. 11 (1988).
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-16 - Exemption For Shared Services › Section 65-16-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule, all terms that are defined
				  in the Act at section 2 thereof have those same meanings which are in some
				  cases further clarified herein. All terms not defined in the Act have the
				  following meanings unless the context expressly requires otherwise.
2.1. "Act" means the certificate of need act,
				W. Va. Code '16-2D-1 et
				seq.
2.2. "Board" means the West
				Virginia Health Care Cost Review Authority which is designated to administer
				the certificate of need program by W. Va. Code '16-29B-11.
2.3. "Verification" means a statement made
				under oath before a notary public that the information is knowingly provided
				and is true and correct.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-16 - Exemption For Shared Services › Section 65-16-3 - Exemption Criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Any
				acute care facility otherwise subject to the certificate of need program may
				obtain an exemption from certificate of need review for shared services between
				two (2) or more acute care facilities. The shared services must be those
				provided by major medical equipment and through existing technology can
				reasonably be made mobile. The major medical equipment which is eligible for
				this exemption is magnetic reasonance imaging (MRI) devices, lithotripters and
				computerized tomography (CT) scanners. On an annual basis the board shall
				review existing technologies to determine if other major medical equipment
				should be included in this exemption. Qualification for an exemption under this
				rule does not constitute a waiver or exemption from certificate of need review
				for the offering of magnetic reasonance imaging, lithotripsy or CT services by
				the acute care facility if these services are provided by major medical
				equipment which is not mobile and is not shared with another acute care
				facility.
3.2. To qualify as a
				"shared service," the equipment must be on site at each acute care facility at
				least four (4) days per month. This requirement may be waived by the board if
				three (3) or more acute care facilities share the equipment.
3.3. This exemption is limited to one piece
				of major medical equipment per shared service. An acute care facility may
				obtain only one exemption for each shared service permitted under this
				rule.
3.4. This exemption is not
				available if the shared services mobile unit is less cost effective than a
				fixed unit. The board shall determine cost effectiveness based upon patient
				charges.
3.5. This exemption is not
				available if any non-acute care facility or entity will utilize the major
				medical equipment for the provision of health services to that facility's or
				entity's patients. The equipment may be owned by a non-acute care facility or
				entity, which in turn contracts, leases, or rents it exclusively for use by
				acute care facilities.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-16 - Exemption For Shared Services › Section 65-16-5 - Requests For Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. If
				an affected person requests a hearing, the board shall terminate the exemption
				review period. The board or its designee shall hold a hearing within thirty
				(30) days of the request for a hearing unless the board sets a later date upon
				a showing of good cause.
5.2. The
				board or its designee may conduct a prehearing conference in accordance with
				Rule 16 of the West Virginia Rules of Civil Procedure. If an order is first
				obtained from the board or a hearing examiner appointed by it, the parties may
				engage in discovery as provided by the West Virginia Rules of Civil Procedure;
				except that the scope of discovery is limited to relevant and admissible
				evidence.
5.3. At the conclusion of
				the hearing, the parties may submit proposed findings of fact, conclusions of
				law, and legal briefs. The board has ten (10) days from the receipt of those
				items or the closure of the record if those items are not tendered to make its
				determination in writing.
5.4. A
				written decision made pursuant to subsection 5.3 is a final decision. The board
				shall publish notice of the decision in the Saturday Charleston newspapers and
				the State Register. The applicant shall not acquire or contract for the major
				medical equipment until after entry of a final decision by the board.
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 65-17-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule specifies which health services, major medical equipment,
				and/or facilities acquired, offered or developed by health professionals are
				subject to certificate of need review.
1.2. Authority. -- W. Va. Code, §§
									16-2D-4(a)(1),
				16-2D-8(c).
1.3. Filing Date. -- March 29,
				2007.
1.4. Effective Date. -- March
				29, 2007.
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 65-17-3 - Health Services, Major Medical Equipment and/or Facilities

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. One or more
				health professionals licensed to practice in this state pursuant to the
				provisions of Chapter 30 of the West Virginia Code who wish to acquire, offer
				or develop one or more of the health services, major medical equipment and/or
				facilities listed in subsection 3.3 of this rule shall follow the procedures
				set forth in the Health Care Authority's legislative rule, "Certificate of
				Need," 65 CSR 7.
3.2. If a health
				service, major medical equipment and/or facility is one set forth in subsection
				3.3 of this rule, the proposed acquisition, development or offering of that
				service, equipment and/or facility by a licensed health professional is subject
				to review regardless of the cost associated with the proposal, except for
				diagnostic centers as set forth in subdivision 3.3.i of this rule.
3.3. The list of health services, major
				medical equipment and/or facilities subject to review pursuant to W. Va. Code
				§
									16-2D-4(a)(1)
				is as follows. This list is all inclusive and may not be altered except by
				amendment to this legislative rule.
3.3.a.
				End-stage renal dialysis stations and home training.
3.3.b. Lithotripsy.
3.3.c. Radiation therapy.
3.3.d. Magnetic resonance imaging
				(MRI).
3.3.e. Proton emission
				tomography (PET).
3.3.f. Cardiac
				catheterization.
3.3.g. Birthing
				centers.
3.3.h. Ambulatory surgical
				facilities or ambulatory surgical centers.
3.3.i. Diagnostic centers.
3.3.j. CT (computed tomography)
				scanning.
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 65-17-4 - Batching Category

Current through Register Vol. XLI, No. 28, July 12, 2024
All applications received pursuant to this rule shall be
				  considered by the state agency in the applicable batching category as described
				  in the Health Care Authority's legislative rule, "Certificate of Need," 65 CSR
				  7.
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 65-19-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.2.
Authority
- W. Va. Code § 16-29B-20G ) and §
				16-29B-8(a)(1).
1.3.
Filing Date
-___________________________.
1.4.
Effective
				Date
-______________________________.
1.5. This legislative rule repeals and
				replaces section 5 of the "Procedural Rule for Requests For Automatic Rate
				Changes," §65 C.S.R. 3.
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 65-19-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This legislative rule implements certain of the provisions of
				  Enrolled Committee Substitute for H. B. 2194 which became effective on March
				  20, 1991. That bill amended W. Va. Code, S16-29B-20 by amending subsection (j).
				  This amended subsection authorizes the state agency to promulgate rules to
				  develop an automatic review process for rate increase requests from hospitals
				  licensed for one hundred {100} beds or less which are not located in a standard
				  metropolitan statistical area where the rate of inflation is equal to or less
				  than the lowest rate of inflation as established by a recognized inflation
				  index for either the national or regional hospital industry.
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 65-19-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, all terms have the same meaning as
				  provided in the definition section of the Health Care Cost Review Authority
				  Act, W. Va. Code, § 16-293-3. Definitions of additional terms are set
				  forth in this section and whenever these terms are used, the definitions in
				  this section apply, except where the context may expressly otherwise
				  require.
3.1. "Authority" means the
				West Virginia Health Care Cost Review Authority.
3.2. "DRI" refers to the inflation index for
				the hospital industry published by Data Resources/McGraw Hill.
3.3. "Gross Revenue" means a hospital's gross
				patient revenue plus all operating and nonoperating revenues from whatever
				source.
3.4. "Hospital" means:
3.4.1.- A facility subject to licensure as
				such under the provisions of W. Va. Code, §
										16-5B-1
et
				seq
.
3.4.2. Any acute
				care facility operated by the state government which is primarily engaged in
				providing to inpatients, by or under the supervision of physicians, diagnostic
				and therapeutic services for medical diagnosis, treatment and care of injured,
				disabled or sick persons; but, in either event, does not include state mental
				health facilities, facilities primarily engaged in rendering psychiatric
				diagnosis, treatment and care or state long-term care facilities.
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 65-19-5 - Failure to comply with rules

Current through Register Vol. XLI, No. 28, July 12, 2024
Failure by a hospital or an interested party to comply with
				  any of the requirements of these rules shall subject the hospital or the
				  interested party to the penalties provided by W. Va. Code, §
									16-29B-1
et
				  seq.
, and the denial of all requested relief in an appropriate
				  case. Failure by a hospital or an interested party to comply with the time
				  limits set forth in this rule may also, in the discretion of the board, cause
				  the time limits to be extended and the hospital or interested party is
				  considered to have waived the time periods set forth in W. Va. Code, §
				  16-29-8 -1
et seq.
, and these rules or the board may
				  impose another appropriate sanction.
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 65-19-6 - Health care facility financial disclosure act

Current through Register Vol. XLI, No. 28, July 12, 2024
Before any application for a rate increase will be accepted
				  for review, the hospital must be in compliance with the Health Care Facility
				  Financial Disclosure Act, W. Va. Code, §
									16-5F-1
et
				  seq.
If the hospital is not in compliance with all financial
				  disclosure requirements the Authority shall refuse to accept the application or
				  request and to reject it.
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 65-19-7 - Additional information

Current through Register Vol. XLI, No. 28, July 12, 2024
Should the Authority require additional information from a
				  hospital or an interested party, then, in the discretion of the Authority the
				  various time limits imposed by this pule shall be tolled until the information
				  is received by the board.
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 65-19-8 - Time periods

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1 Where
				a time period is provided for in this rule, the period is intended to be a
				maximum period. In the event a given requirement is completed sooner than the
				stated period by the Authority, a hospital or an interested party, then the
				next time period, if any, begins to elapse upon the actual date the requirement
				is completed.
8.2. Calculation of
				time periods - Whenever in this rule the date by which some action is directed
				to be taken or accomplished falls on a Saturday, Sunday or a state holiday,
				then the time for taking or accomplishing the action is extended to the next
				day which is not a Saturday, Sunday or a state holiday.
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 65-19-9 - Decisions and records available

Current through Register Vol. XLI, No. 28, July 12, 2024
Decisions and records of the Authority may be inspected in
				  accordance with W. Va. Code, § 296-1-3 and may be copied at a charge of
				  twenty-five cents ($.25) per page.
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 65-19-10 - Compliance reports

Current through Register Vol. XLI, No. 28, July 12, 2024
Every hospital shall file a compliance report for each
				  quarter of its fiscal year. The compliance report shall be filed within sixty
				  (60) days after the end of each quarter of the fiscal year. The information
				  requested for the compliance report shall be listed on forms to be provided by
				  the Authority.
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 65-19-11 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provisions of this rule or the application thereof to
				  any person or circumstance is held invalid, such invalidity shall not affect
				  the provisions or applications of this rule which can be given effect without
				  the invalid provisions or application and to this end the provisions of this
				  rule are severable.
Click Here To
				  View Image
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes the criteria and standards for certificate of need review for
				the conversion by hospitals of acute care beds to skilled nursing care beds
				which are medicare certified only by licensed hospitals as provided by W. Va.
				Code '16-2D-5(i).
1.2. Authority. -- W. Va. Code ''16-2D-5(i),
				16-2D-8.
1.3. Filing Date. -- April
				10, 1992.
1.4. Effective Date. --
				April 10, 1992.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule implements certain provisions of Enrolled Committee
				  Substitute for House Bill 2194 which was passed by the Legislature on March 6,
				  1991, and was signed by the Governor on March 20, 1991. The bill created a new
				  code section, W. Va. Code '16-2D-5(i).
				  This section authorizes the Health Care Cost Review Authority to promulgate
				  rules for the certificate of need review of applications for the conversion by
				  hospitals of acute care beds to skilled care beds which are only medicare
				  certified.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in these regulations, all terms have the same meaning
				  as provided in the definition section of W. Va. Code '16-2D-2. Definitions
				  set forth in the section amplify and clarify the statutory definitions or
				  define terms not specifically set forth in the statute.
3.1. Acute-care bed complement -- The number
				of licensed hospital beds designated for acute care services exclusive of
				skilled nursing facility (SNF) and/or intermediate care facility (ICF)
				long-term care beds and personal care beds.
3.2. DRG -- Diagnostic related group -- a
				classification system utilized by medicare to group patients with respect to
				resource use.
3.3. Licensed bed
				capacity -- The total number of hospital beds a hospital is currently
				authorized to operate by the Department of Health and Human
				Resources.
3.4. Skilled nursing bed
				-- A long-term care bed designated as an SNF (skilled nursing facility bed) and
				certified as such under Medicare Title XVIII reimbursement.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-4 - Application

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. An application
				for a certificate of need shall be on forms approved by the board. The original
				and three (3) copies of the application must be submitted to the board. The
				application must be verified under oath by the Chief Executive
				Officer.
4.2. Application required
				for Certificate of Need. Information required for the application includes the
				following:
4.2.1. The identification of the
				applicant;
4.2.2. An authorization
				to pursue the project;
4.2.3. A
				description of the project;
4.2.4.
				A timetable for implementation of the project;
4.2.5. An analysis of the need for the
				project;
4.2.6. The policies for
				patient admission and provision of fully or partially uncompensated
				care;
4.2.7. An analysis of
				alternatives to the project;
4.2.8.
				An analysis of the project's relationship to the existing long term skilled
				care services in the area;
4.2.9.
				An analysis of the relationship of the project to the hospital's long-range
				plan;
4.2.10. An analysis of
				competitive factors;
4.2.11. The
				relationship of the project to licensure, certification, accreditation and
				safety standards;
4.2.12. The
				availability of resources and manpower;
4.2.13. A preliminary financial feasibility
				study -- The hospital must demonstrate that the proposed project is financially
				feasible and at a minimum provide the following:
4.2.13.a. Statements of (a) revenues and
				expenses, (b) balance sheet, (c) statement of changes in fund balances, and (d)
				statement of cash flow for the last two (2) years. Audited financial statements
				shall be submitted, if available;
4.2.13.b. A preliminary financial feasibility
				study and cash flow statements for the proposed medicare skilled nursing care
				unit for a three (3) year period including, at a minimum, pro forma financial
				statements for the current fiscal year and three (3) future years along with
				all assumptions upon which the projections were based.
4.2.13.c. An impact analysis or study that
				demonstrates the effect of the proposed project on the hospital's overall
				financial condition.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-5 - Additional Information or Amendments to Application

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. After the review of an application has
				begun, the board may require the applicant to submit additional information. If
				no hearing is requested upon the application, and the applicant fails to submit
				the information within the time directed, or if the applicant submits a
				substantial amendment to its application, the board may:
5.1.1. Extend the review cycle pursuant to
				the provisions of 65 CSR 7, section 13;
5.1.2. Enter an order closing the file ten
				(10) days from the entry of such order; or
5.1.3. Withdraw the application from
				review.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-6 - Application Withdrawal

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. An
				application under consideration by the board may be withdrawn by the applicant
				at any time prior to the issuance of a final decision and written findings. The
				withdrawal of the application is without prejudice.
6.2. A written notice withdrawing the
				application must be filed with the board before the issuance of a final
				decision.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-7 - Batching of Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. All
				applications shall be batched in the appropriate batching category pursuant to
				65 CSR 7, section 10.
7.2.
				Applications will be reviewed in four (4) annual cycles. On the first Friday of
				the months of February, May, August and November, the board will collect by
				batching categories all applications determined to be complete since the
				previous cycle. The board shall then establish a ninety (90) day review cycle
				for each category. For consideration in any batch cycle, the application must
				be submitted no later than fifteen (15) days prior to the beginning of the
				batch.