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 65-14-4 - Expedited Review

Current through Register Vol. XLI, No. 28, July 12, 2024
Any hospital which is licensed for more than one hundred
				  (100) beds or that is located in a Standard Metropolitan Statistical Area which
				  wishes 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.
Application, license and
				budget
- The hospital shall file an application with the Authority
				at least forty-five (45) days prior to the beginning of its fiscal year on a
				form to be provided by the Authority. The application submitted by the hospital
				shall include the following: the hospital's inpatient and outpatient
				utilization for the previous fiscal year, the current fiscal year and the
				projected inpatient and outpatient utilization for the fiscal year affected by
				the increase; the amount of gross inpatient and outpatient revenue received by
				the hospital during the previous fiscal year, the current fiscal year and the
				projected amount of gross inpatient and outpatient revenue for the year
				affected by the increase; the amount of contractual allowances, uncollectable
				accounts, charity care, operating expenses, other operating revenue,
				non-operating revenue interest, non-operating revenue gifts, and non-operating
				revenue other for the previous fiscal year, the current fiscal year and the
				projected amount for the fiscal year affected by the increase. The hospital
				shall submit with its application a copy of its current license issued by the
				state director of health pursuant to West Virginia Code 16-5B-1
et
				seq.
The hospital shall also submit with its application a copy of
				"the budget approved by the hospital's board for the fiscal year affected by
				the. increase. The budget must contain all usual information under generally
				accepted accounting principles for a budget and a full and specific statement
				of ail assumptions relied upon in preparing the budget. The application shall
				include a certification by the chief executive officer and the chairman of the
				board of the hospital that the information contained therein is true and
				accurate.
4.2.
Eligibility
				standards
- Upon receipt of the application, license and budget,
				the Authority shall determine:
(1) if a
				minimum of 365 days have elapsed since the hospital has placed into effect its
				last rate increase. Temporary changes in a hospital's rates made pursuant to W.
				Va. Code
				16-29B-21(b)
				are excluded from this requirement; and,
(2) if the hospital in its current fiscal
				year has provided charity care equal to or greater than the most recent state
				average as published by the Authority. Charity care shall be determined in
				accordance with the guidelines contained in the Hospital Cost Containment
				Methodology - Phase I, Sections 3.4.9.1, 3.4.9.1a, 3.4.9.1b, 3.4.9.1c and
				3.4.9.1d (65 C.S.R. 5) and shall not include bad debt. The Authority shall also
				review any or . all of the following revenue limits to determine if the
				hospital has experienced an excess in these categories:
(1) gross revenue,
(2) gross patient revenue,
(3) gross inpatient revenue,
(4) charges per discharge; and,
(5) gross outpatient revenue. No hospital
				will be determined ineligible to request an expedited rate increase pursuant to
				this rule if the data submitted indicates an excess in gross outpatient revenue
				or an excess in gross revenue or gross patient revenue if the excess is
				directly attributable to the excess In gross outpatient revenue.
If the Authority determines the hospital has met these
				  standards the hospital is eligible to request an expedited rate increase
				  pursuant to this rule. If the hospital fails to meet these standards, the
				  hospital shall not request a rate increase pursuant to this rule.