West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-4 - Certificate of Need 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 applicant shall submit the original and three (3) copies of the
				application to the board. The application shall have a verification signed by
				the Chief Executive Officer and the person or persons who prepared the
				application.
4.2. The application
				shall, at a minimum, include the following:
4.2.a. The identification of the
				applicant;
4.2.b. A copy of the
				governing body's approval of the proposal and its written authorization
				empowering specified individuals to sign the application and to act on its
				behalf;
4.2.c. A description of the
				project;
4.2.d. A timetable for
				implementation of the project, including the projected date for incurring the
				obligation for any capital expenditure;
4.2.e. A documented analysis of the need of
				the population to be served by the project, including the medically
				underserved, and the extent to which the proposed service will be accessible to
				the population;
4.2.f. Policies for
				patient admission and provision of fully or partially uncompensated
				care;
4.2.g. A documented analysis
				of alternatives considered by the applicant;
4.2.h. A documented analysis of the
				proposal's relationship to the existing health care system, including providers
				of direct, ancillary, and support services and health professional training
				programs in the area in which services are to be provided, and, when
				applicable, the extent to which the proposal will meet the needs of those
				training programs;
4.2.i. An
				analysis of the relationship of the proposal to the applicant's long-range plan
				on file with the board;
4.2.j. A
				documented analysis of the proposal's relationship to the state health
				plan;
4.2.k. An analysis of the
				extent to which competition allocates services of the type being proposed and
				promotes quality assurance, cost effectiveness and accessibility;
4.2.l. An analysis of the relationship of the
				proposal to the most recent statements of deficiencies and plans of corrections
				from surveys conducted by accreditation organizations and other federal, state
				and local inspection agencies, as well as copies of those survey reports or
				portions of the reports as may be required by the board;
4.2.m. Documentation of the availability of
				resources, including health care providers, management personnel and funds for
				capital and operating needs;
4.2.n.
				Copies of existing or proposed policies with respect to employment of facility
				staff and, where applicable, admission to medical staff membership;
4.2.o. A preliminary financial feasibility
				study which includes an analysis of historical and projected utilization,
				charges, sources of revenue, statements of revenues and expenses, a statement
				of changes in fund balance, a statement of cash flows, balance sheets, and a
				statement of the specific assumptions upon which the feasibility study was
				based;
4.2.p. Documentation of
				existing or proposed mechanisms for soliciting consumer input into the
				applicant's decision-making process;
4.2.q. In the case of construction projects,
				a documented analysis of the cost and methods of the proposed construction,
				including provisions for energy conservation and the probable impact of the
				proposed construction on the applicant's cost of providing health
				services;
4.2.r. If applicable, a
				documented analysis of the needs or circumstances of entities such as health
				professional schools, multi-disciplinary clinics and specialty centers which
				provide a substantial portion of their services to individuals not residing in
				the health service area in which they are located or in adjacent health service
				areas;
4.2.s. If applicable, a
				documented analysis of the needs and circumstances of research projects;
				and
4.2.t. If applicable, a
				documented analysis of the need and circumstances of health maintenance
				organizations.