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 65-5-8 - Automatic Rate Increase Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
Any hospital which is licensed for one hundred (100) beds or
				  less and is not located in a standard metropolitan statistical area which
				  intends to revise any of its previously approved revenue limits in an amount
				  equal to or less than the inflation factor approved by the Authority shall do
				  so in accordance with this rule, provided that the hospital has previously
				  implemented revenue limits approved by the Authority pursuant to the cost based
				  rate review system and as required by section 6 of this rule.
8.1. Application - The hospital shall file an
				application with the Authority at least ten (10) days prior to the beginning of
				its fiscal year on forms to be provided by the Authority. The hospital shall
				submit with its application a copy of its current license issued pursuant to W.
				Va. 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 all assumptions relied upon in preparing the budget. 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. 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 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. 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.
8.2. The hospital must
				notify the Authority at least ten (10) days prior to instituting the rate
				increase.
8.3. Unless a hearing is
				held pursuant to section 15 of this rule, the Authority shall issue a final
				order approving or disapproving the increase put into effect by the hospital
				within thirty (30) days of receipt of the application. The hospital is not
				prohibited from implementing the rate increase during this thirty (30) day
				period. The Authority's evaluation will establish that the increases in a)
				gross inpatient revenue per day, b) gross inpatient revenue per discharge, c)
				gross inpatient acute care revenue, d) outpatient revenue per visit, and e)
				gross outpatient revenue are equal to or less than the approved inflation
				factor. The determination shall be made upon the facts presented by the
				hospital and the records on file with the Authority. The decision shall be
				treated as a final order.
8.4.
				Within twenty (20) days of receipt of the final order, the hospital must file
				with the Authority a schedule of rates, each of which shall be drafted in
				accordance with the revenue limits set by the final order of the Authority. The
				schedule of rates shall indicate the date of implementation of the rates.
				Thereafter, the Authority shall issue a notice acknowledging receipt of the
				schedule of rates.
8.5. If the
				Authority subsequently determines that the increase put into effect by the
				hospital actually exceeded the rates approved by the Authority, for whatever
				reason, the Authority may institute a review and investigation of the
				hospital's rates and budget and take such action as it deems necessary to
				establish a new rate schedule and also direct a refund to the hospital's
				patients or a temporary decrease in the hospital's rates. The decision
				resulting from any such review and investigation may be treated as a final
				order.
8.6. If the hospital
				experiences less inpatient or outpatient utilization for the twelve (12) months
				following the increase than it had anticipated when the automatic rate of
				inflation increase was obtained, the hospital's average rate per discharge or
				the outpatient revenue per visit shall not later be increased to compensate for
				the decline in revenue without permission of the Authority.
8.7. If the hospital actually experiences
				revenues for non-governmental payors in excess of the limits allowed, then the
				hospital is notified that it is subject to all of the penalties provided for in
				the Act and this rule.
8.8. The
				Authority will continue to monitor the hospital's compliance with the
				Authority's prior orders. Should such monitoring reveal that the hospital
				exceeded its prior approved revenue limits, then the Authority will take
				corrective action against the hospital as a result of that excess and will also
				take corrective action against the rates being charged by the hospital after
				any automatic rate of inflation increase.
8.9. 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.