West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-05 - Hospital Cost-Based Rate Review System › Section 65-5-6 - Procedure for Requesting a Permanent Rate Increase - Standard Application

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Pre-application Conference
Prior to the filing of any rate increase application, a
				  hospital may request a pre-application conference with the Authority's staff.
				  The purpose of said conference is to discuss the information needed to justify
				  the requested increase.
6.2. Standard Application
Every acute care hospital with a fiscal year which ends
				  September 30, 1992, through the period ending August 31, 1993, must file a
				  standard application with the Authority, as further described in this section,
				  a minimum of forty-five (45) days prior to the beginning of its fiscal year.
				  The purpose of this requirement is to allow the Authority to establish revenue
				  limits for every acute care hospital under the cost-based rate review system.
				  Only hospitals specifically and temporarily exempted from this requirement by a
				  consent order signed by the hospital and the Authority may file a standard
				  application at a time otherwise established by the Authority.
For subsequent fiscal years the hospital, if eligible, may
				  file an expedited or automatic rate request. A hospital which does not file an
				  expedited or automatic rate application and which intends to revise any of its
				  previously approved revenue limits must file with the Authority an application
				  containing the information described in this subsection and be in compliance
				  with all other requirements contained in this rule and the Act.
A hospital is not required to annually file a rate
				  application. However, if it intends to revise any of its approved revenue
				  limits, it must do so within the time periods and in accordance with the
				  procedure specified herein. Furthermore, a hospital shall not file more than
				  one rate increase application per fiscal year unless the application is filed
				  pursuant to section 7 of this rule.
The hospital must file its application with the Authority a
				  minimum of forty-five (45) days prior to the beginning of its fiscal
				  year.
The application must contain:
6.2.1. all of the information requested on
				forms provided by the Authority;
6.2.2. a written report, including the
				information described in W. Va. Code '16-29B-21(a)(2);
6.2.3. a proposed budget which is identical
				in content to the budget approved by the hospital's board. The budget must
				contain not only all usual information under generally accepted accounting
				principles for a budget, but must also contain a full and specific statement of
				all assumptions relied upon in preparing the budget;
6.2.4. in the event the hospital has
				implemented a new service within the previous twelve (12) months, a request for
				an adjustment in gross patient revenue due to the implementation of a new
				service must be supported by a certificate of need decision, if applicable. The
				request must also include projected utilization, a rate schedule and an
				operating budget detailing the revenues and direct expenses for the new
				service;
6.2.5. in the event the
				hospital intends to obtain approval of any discount contract pursuant to W. Va.
				Code '16-29B-20, the
				hospital shall also file with the Authority all of the information requested on
				forms provided by the Authority, which shall include an explanation of the
				requirements set forth in W. Va. Code '16-29B-20; the
				hospital shall also file a summary of the basic terms of the contract; a copy
				of the proposed discount contract; and, any other information required by the
				Authority. The Authority shall approve or deny the proposed discount contract
				within the one hundred eighty (180) day time period for review of rate
				applications set forth in subsection 6.5 of this rule. All information
				contained in the proposed discount contract or related thereto shall be subject
				to public disclosure as a public record. The provisions of this rule for
				consideration of discount contracts in the rate review process shall supplement
				the provisions for retroactive review of discount contracts for certain border
				hospitals pursuant to W. Va. C.S.R. '65-22-1, et seq., insofar as such
				provisions relate to such retroactive review of discount contracts for border
				hospitals previously temporarily approved under C.S.R. '65-22-1, et seq., and
				otherwise the provisions under C.S.R. '65-22-1, et seq., regarding temporary
				approval of discount contracts for certain border hospitals shall apply to the
				temporary approval thereof.
6.2.6.
				such additional information as the hospital chooses to submit or the Authority
				may require.