West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-03 - Procedural Rules For The Projecting Of Gross Revenues For Hospitals, Setting The Amount Of Net Revenues Over Expenditures For Hospitals And Settings › Section 65-03-4 - Permanent changes in the schedule of rates

Current through Register Vol. XLI, No. 28, July 12, 2024
Except as provided for by section 5 of this rule, any
				  hospital which wishes to change or amend any portion of its previously approved
				  schedule of rates shall file an application and proposed budget as described
				  below with the Authority. The hospital may prior to the filing of any rate
				  increase application request a pre-application conference with the Authority's
				  staff. The purpose of the conference will be to discuss the information needed
				  to justify the requested increase,
4.1. Application and proposed budget - The
				application shall contain information requested on forms provided by the
				Authority as attached hereto. In addition, the hospital must provide, In a
				written report, the information described in West Virginia Code, subdivision
				(2), subsection (a), section twenty-one, article twenty-nine-b, chapter
				sixteen. The proposed budget should be 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. The hospital may also submit such additional
				information as it wishes. All applications for adjustments in gross patient
				revenue due to a new service should be supported by a certificate of need
				decision, if applicable. The request must also include projected utilization, a
				rate schedule and an operating budget which details revenues and direct
				expenses for the new service.
4.2.
				Public hearing - Upon receipt of the application and proposed budget, the
				board, if it considers necessary, may hold a public hearing on any proposed
				change or amendment. Such hearing shall be held no later than forty-five (45)
				days after receipt of the application and proposed budget. The hospital or an
				interested party may request a hearing which request may, in the discretion of
				the board, be granted.
4.3.
				Hearings - The hearing shall be conducted pursuant to the provisions of West
				Virginia Code, section twelve, article twenty-nine-b, chapter sixteen, and West
				Virginia Code, section one, article five, chapter twenty-nine-a et seq. In
				addition, the Rules of Procedure for Contested Case Hearings and Declaratory
				Rulings, article one, chapter sixteen. Series I (1983), heretofore promulgated
				by the West Virginia Board of Health on December 30, 1982, are incorporated
				herein by reference and shall supplement the aforesaid Code provisions. The
				board or the hearing examiner may schedule and require attendance at a
				prehearing conference to be conducted by an officer appointed for that purpose
				by the board. The purposes of the prehearing conference shall be similar to the
				purposes of Rule 16, West Virginia Rules of Civil Procedure.
4.4. Review by the board - Upon receipt of
				the hospital's application and proposed budget, the Authority's staff shall
				submit to the board a proposed gross revenue limit and gross patient revenue
				limit for that hospital. The Authority's staff may also request a conference
				with the hospital's officials and any interested persons. Thereafter, the board
				shall issue an interim order setting the hospital's revenue limits. The interim
				order shall be sent by certified mail, return receipt requested, to the
				hospital. Within forty-five (45) days of receiving the interim order, the
				hospital shall file with the board a revised proposed budget and a proposed
				schedule of rates, each of which shall be drafted in accordance with the
				revenue limits set by the board. Thereafter, the board shall issue a final
				order setting final revenue limits, the hospital's budget and schedule of
				rates. The final order shall specify the effective date of any proposed
				changes. The final order shall be sent by certified mail, return receipt
				requested, to the hospital. The hospital's community shall be notified of the
				final order through an announcement in the local media. Such notice shall not
				issue until twenty-four (24) hours after the final order is mailed to the
				hospital.
The final order on any proposed change or amendment shall not
				  be issued more than one hundred eighty (180) days from the date of filing of
				  the application and proposed budget with the board. If the board fails to
				  complete its review of the proposed change within the time period specified for
				  the review, the proposed change shall be deemed to have been approved by the
				  board.
4.5. Appeals from
				board's final order - Should the hospital or an interested party wish to
				contest the board's final order, the hospital or interested party shall file
				its appeal pursuant to the provisions of West Virginia Code, section thirteen,
				article twenty-nine-b, chapter sixteen.
4.6. Rates during hearings and appeals - In
				the event the board modifies the request of a hospital for a change in its
				rates so that the hospital obtains only a partial increase in its rate
				schedule, the hospital shall have the right to accept the benefits of the
				partial increase in rates and charge its purchasers accordingly without in any
				way adversely affecting or waiving its right to contest or appeal that portion
				of the decision and final order of the board which denied the remainder of the
				requested rate increase. Similarly, if an interested party contests or appeals
				the decision and final order of the board, the hospital may charge its
				purchasers in accordance with the board's decision and final order until the
				final order is subsequently modified.
4.7. Notice to the community -
				Contemporaneously with the filing of the application and proposed budget
				pursuant to section 4 of this rule, the hospital shall also cause to be
				published in a newspaper of general circulation in the county in which the
				hospital is located a legal advertisement setting forth the fact that the
				hospital is applying to the board for a change or amendment to its schedule of
				rates. The legal advertisement shall summarize the effect of the requested
				relief and shall further state that any person desiring to inspect the
				application and proposed budget may do so at the hospital during the hospital's
				regular business hours and also at the offices of the board. Also, the legal
				advertisement shall advise the public that any person or entity who claims to
				be an interested party in the proceedings for the changing or amending of the
				schedule of rates must file with the Authority a written notice setting forth
				the interested parties' names, address and the facts relied upon to establish
				his or her interest. The legal advertisement must inform the public that
				interested parties must file this notice within thirty (30) days of the
				hospital's filing of its application with the Authority or else the Authority
				will, except for good cause shown, deny the interested party's notice. The
				Authority will then send notices of all proceedings and copies of all orders to
				those parties deemed to be interested in the matter. Proof of publication of
				the legal advertisement by the hospital must be submitted to the Authority
				within ten (10) days of the filing of its application and proposed
				budget.
4.8. Reconsideration - In
				the event that a hospital or interested party wishes the board to reconsider a
				prior order, it shall file its request in writing and shall detail the grounds
				for the reconsideration. Such a request must be filed within twenty (20) days
				of the receipt by the hospital of the disputed order. A request for
				reconsideration shall toll the running of the period in which an appeal must be
				taken. The board shall respond to the request for reconsideration in writing
				and shall state its reasons for granting or denying the request.