West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-23 - Exemptions For New Primary Care Services › Section 65-23-4 - Exemption Procedure

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Each
				applicant seeking an exemption pursuant to this rule, must file with the board
				a letter of intent at least fifteen (15) days before the submission of the
				application. The letter of intent shall contain sufficient information to
				advise the board of the nature of the exemption sought and outline the grounds
				for the exemption.
4.2. Upon
				receipt of the letter of intent, the board shall publish a notice in the
				Saturday Charleston newspapers and the State Register. The notice shall
				identify the legal entity seeking an exemption, the type of exemption
				requested, and a description of the proposal. The notice shall also state the
				rights of affected parties to a hearing.
4.3. In order to obtain the exemption, each
				applicant must file an application with the board no sooner than the fifteenth
				day or later than the thirtieth day following the filing of the letter of
				intent. The application shall contain the following:
4.3.1. Information that demonstrates that the
				applicant meets the exemption criteria required by subsections 3.1.1, 3.1.2,
				and 3.1.3 of this rule;
4.3.2. A
				copy of the applicant's by-laws and a list of the governing board, including
				the name, occupation, address, and telephone number of each board member. The
				by-laws must fully describe the composition of the community board;
4.3.3. Appropriate documentation of the
				applicant's tax exempt non-profit status, such as a copy of the organization's
				501(c)(3) non-profit letter or a copy of the application for such designation;
				or evidence that the applicant is designated a government entity;
4.3.4. A map detailing the geographical
				boundaries of the applicant's existing and projected service area and an
				estimate of the population within the service area, with an explanation of how
				the population figure was derived. The map shall show the mileage from the site
				of the proposed new services to other sites operated by community-based primary
				care organizations in the service area;
4.3.5. An assurance that people residing in
				the area to be served by the new services will receive the services without
				regard to ability to pay;
4.3.6. A
				description of the financial feasibility of delivering and maintaining the
				proposed new services, of the start-up funding involved, the applicant's
				budget, most recent audit, and financial statement and capital expenditures for
				the project;
4.3.7. A listing of
				projected physician(s), other practitioners, administrators, and other site
				staff to be employed by the organization, if available, identified by name, and
				in addition, a summary of what recruitment prospects exist or are being planned
				for vacant positions;
4.3.8. A
				timetable of the projected opening of the site to include source of funding,
				recruitment plans, occupancy (lease, rent, purchase, or construct), staffing,
				and other factors relevant to the opening of the site;
4.3.9. Information with respect to the
				projected annual number of users and encounters to be served at the site. In
				instances involving an existing provider of primary care services, actual
				information regarding the operating budget, users, and encounters is to be
				provided; and
4.3.10. A
				verification signed by the chairperson of the community board.