West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-03 - Procedural Rules For The Projecting Of Gross Revenues For Hospitals, Setting The Amount Of Net Revenues Over Expenditures For Hospitals And Settings › Section 65-03-6 - Temporary changes in a hospital's rates

Current through Register Vol. XLI, No. 28, July 12, 2024
The legislative rules for the freeze on hospital rates and
				  granting of temporary rate increases, West Virginia Code, article
				  twenty-nine-b, chapter sixteen, Series II (1983), were drafted to implement
				  Section 4 of the Act and to implement former Section 21(e) of the Act insofar
				  as it pertained to Section 4 of the Act. Those rules do not have applicability
				  to changes or amendments to a hospital's rate schedule.
6.1. Application for temporary rate change -
				In the event a hospital desires to obtain a temporary change in its schedule of
				rates, the hospital shall submit an application to the Authority which
				addresses the criteria set forth in Section 21(b) of the Act. The application
				must describe in detail the facts in support of the temporary rate change, the
				amount of increases in rates required to alleviate its situation, and shall
				summarize the overall effect of the rate increase. The claim shall be verified
				(that is, sworn to under oath) by either the chairman of the hospital's
				governing body or by the chief executive officer of the hospital.
6.2. Immediate effectiveness of application -
				Upon receipt by the board of the application for a temporary rate change, the
				rate change shall be effective, at the hospital's discretion, immediately and
				until such time as the board may inform the hospital that the temporary rate
				change is to be modified to a stated amount or is not approved. If the rate
				increase is modified so that the hospital is granted only a partial increase in
				its rate schedule, the hospital may charge at the rate assigned by the board
				without resubmitting a request. The board's decision may be treated as a final
				order and an appeal or reconsideration may be requested by the hospital or an
				interested party pursuant to sections 4.5 and 4.8 of this rule. The order shall
				be issued by certified mail, return receipt requested, to the hospital. The
				final order shall set final revenue limits, the hospital's budget, and schedule
				or rates. The final order shall specify the effective date of any proposed
				changes.
The final order on any proposed change or amendment shall not
				  be issued more than one hundred eighty (180) days from the date of filing of
				  the application with the board. If the board fails to complete its review of
				  the proposed change within the time period specified for the review, the
				  proposed change shall be deemed to have been approved by the board.
6.3. Preferential review of
				application - After receipt of the claim for a temporary rate change, the board
				shall extend preference to hospitals demonstrating immediate risk of
				insolvency, or demonstrating substantial financial hardship, to maintain
				accreditation or for emergency repairs which in the discretion of the board
				justify temporary rate changes prior to the commencement of full review of the
				proposed rate change.
6.4. Full
				review of application - All claims for a temporary change in a hospital's
				schedule of rates shall be subject to full review by the board in accordance
				with the principles stated in section 4 et seq. of this rule; except that, the
				hospital shall cause the required legal advertisement to be published within
				seven (7) days of filing of the application for a temporary rate change and the
				hospital need not submit the information normally contained in a Section 4.1
				application and proposed budget, unless such information is subsequently
				requested by the board.
6.5.
				Following its review of the requested increase, the Authority may allow the
				temporary rate increase to become permanent, to deny any increase at all, to
				allow a lesser increase, or to allow a greater increase. In the event the
				Authority desires to deny or reduce the increase, the Authority may choose to
				either order a refund or a temporary rate decrease so as to compensate the
				hospital's patients and community for the disallowed increase while it was in
				place.
6.6. Hearings - In the event
				that either the Authority, a hospital, or an interested party requests a
				hearing on the increase, the hearing shall be conducted pursuant to section 4.3
				of this rules.