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 65-03-5 - Automatic rate of inflation increases

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Any hospital which wishes to increase
				its gross inpatient revenues per discharge for nonmedicare and nonmedicaid
				payors in an amount equal to or less than the rate of inflation for the
				hospital industry nationally shall do so in accordance with this
				rule.
5.2. At least five (5) days
				prior to instituting the increase, the hospital must notify the Authority of
				its intention to implement the increase. The notice shall include completion of
				the form attached to these rules for such increases.
5.3. The hospital must inform the Authority
				of its inpatient utilization during the fiscal year prior to the date of the
				notice and the anticipated inpatient utilization for the fiscal year affected
				by the increase. The hospital shall also inform the Authority of the amount of
				gross inpatient revenue it received for the fiscal year prior to the increase
				and the amount of gross inpatient revenue it expects to receive during the
				fiscal year affected by the increase.
5.4. Within thirty (30) days after
				implementing the increase in its gross inpatient revenues per discharge for its
				nonmedicare and nonmedicaid payors, the hospital shall file an amendment to its
				schedule of rates and a revised budget both reflecting the effect of the
				increase.
5.5. The hospital shall
				determine the applicable rate of inflation for the hospital industry by
				referring to the most recent "hospital and related services" item of the
				Consumer Price Index for all urban consumers as reported by the United States
				Bureau of Labor Statistics for the hospital's immediately completed fiscal
				year. The hospital may request the Authority to provide it with this figure
				prior to filing the notice required by section 5.2 of this rule. The rate of
				inflation so reported shall not be adjusted for increasing costs of technology,
				increases in nonsupervisory wages, malpractice premiums, new services, or any
				other reason.
5.6. Within thirty
				(30) days of receiving the hospital's schedule of rates and revised budget as
				required by section 5.4, the Authority shall issue a decision approving or
				disapproving the increase put into effect by the hospital. The hospital is not
				prohibited from implementing the rate increase during this thirty (30) day
				period. The HCCRA's evaluation will be limited to the rate of increase for
				gross inpatient revenues per discharge for nonmedicare and nonmedicaid payors
				and will establish that the increase is equal to or less than the rate of
				inflation for the hospital industry nationally. The determination shall be made
				upon the facts presented by the hospital and the records on file with the
				Authority. The decision may be treated as a final order and an appeal or
				reconsideration may be requested by the hospital or an interested party
				pursuant to sections 4.5 and 4.8 of this rule.
5.7. Notwithstanding the provisions of
				section 5.6 of this rule, if the board subsequently determines that the
				increase put into effect by the hospital actually exceeded the national rate of
				inflation for the hospital industry, for whatever reason, the board 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 if any of such should prove necessary. The decision resulting
				from any such review and investigation may be treated as a final order and an
				appeal or reconsideration may be requested by the hospital or an interested
				party pursuant to sections 4.5 and 4.8 of this rule.
5.8. This section also applies to any
				hospital which seeks to increase or decrease its outpatient revenue or its
				nonpatient revenues from nonmedicare or nonmedicaid sources. In addition, if
				the hospital experiences less inpatient 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
				shall not later be increased to make up for the decline in gross inpatient
				revenue without permission of the board.
5.9. For hospitals which have obtained an
				automatic rate of inflation increase, if the hospital actually experiences
				gross inpatient revenues per discharge for nonmedicare and nonmedicaid payors
				in excess of the amount it was allowed, then the hospital is notified that it
				may be subject to all of the penalties provided for by the Act including
				refunds and temporary rate decreases as provided for by West Virginia Code,
				subsection (d) of section twenty-one, article twenty-nine-b, chapter sixteen,
				and also the criminal provisions of West Virginia Code, section twenty-seven,
				article twenty-nine-b, chapter sixteen. Such liability will be determined by
				reference to those sections and not by these rules.
5.10. Hearings - In the event that either the
				Authority, the hospital, or an interested party requests a hearing on the
				increase, the hearing shall be conducted pursuant to section 4.3 of this
				rule.
5.11. While the automatic
				rate of inflation increase will be calculated upon the actual average revenue
				per discharge for the hospital's past fiscal year, the board will continue to
				monitor the hospital's compliance with the board's prior orders. Should such
				monitoring reveal that the hospital exceeded its prior revenue limits, then the
				board 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.