West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-22 - Temporary Approval Of Discount Contracts For Border Hospitals › Section 65-22-5 - Notice

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. In order for a
				border hospital to obtain temporary approval of a discount contract in the
				manner set forth in section four of this rule, the border hospital shall file a
				verified notice with the Authority, which shall be filed at least five (5) days
				in advance of the date upon which the proposed discount contract is to be
				considered temporarily approved and shall:
5.1.1. Identify the border
				hospital.
5.1.2. State
				affirmatively that the border hospital is located within ten (10) miles of the
				border of the State of West Virginia.
5.1.3. State affirmatively that the border
				hospital is located within ten (10) miles of an out-of-state hospital which has
				a similar number of beds and array of services as the border
				hospital.
5.1.4. State
				affirmatively that the border hospital would be at risk to lose a significant
				portion of patients to out-of-state hospitals if the discount contract is not
				temporarily approved and if the discount contract is not confidentially
				maintained by the Authority upon its filing and continuing thereafter until the
				retroactive review of the temporary approval.
5.1.5. Identify the out-of-state hospital or
				hospitals.
5.1.6. State the number
				of licensed beds of the border hospital.
5.1.7. State the number of licensed or
				registered beds of the out-of-state hospital or hospitals as identified by the
				appropriate state department of health.
5.1.8. List the array of services offered by
				the border hospital.
5.1.9. List
				the array of services offered by the out-of-state hospital or hospitals
				according to the American Hospital Association's most recent hospital
				guide.
5.1.10. Identify the entity
				with which the border hospital has contracted.
5.1.11. State the total gross and net patient
				revenue of the border hospital each year for the past three years.
5.1.12. Project the gross and net patient
				revenue which the border hospital shall generate each year during the term of
				the discount contract.
5.1.13.
				State affirmatively that the discount shall not decrease the charges for the
				services below the actual cost to the hospital.
5.1.14. State affirmatively that the cost of
				the discount shall not be shifted to any other purchaser or third-party
				payor.
5.1.15. State affirmatively
				that the discount shall not result in a decrease in the border hospital's
				proportion of medicare, medicaid, or uncompensated care patients.
5.1.16. State affirmatively that the discount
				is based on criteria which constitute a quantifiable economic benefit of the
				border hospital.
5.1.17. Include a
				copy of the discount contract, which shall be confidential for the purpose only
				of obtaining temporary approval of the contract in accordance with subsection
				6.3 of this rule.
5.1.18. Present
				such other and further information or documents as may be requested by the
				Authority.