reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-8 - Application Review Procedure

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1.
				Applicants must file a letter of intent with the board at least fifteen (15)
				days before the submission of a formal application. The letter of intent must
				contain sufficient information to advise the board of the nature, scope, cost
				and timing of the project, as well as the location and name of the proposed
				applicant. Letters of intent are effective for one (1) year from the date of
				their filing.
8.2. Upon receipt of
				a certificate of need application, the board shall determine whether the
				application is complete or whether additional information is required. A
				declaration by the board that an application is complete means that there is
				sufficient information contained in the application for the board to make an
				informed decision. It does not mean that the approval of the application is
				warranted. Except in emergency situations that pose a threat to the public
				health, an application shall not be declared complete if:
8.2.1. A long-range plan with a sufficient
				level of detail acceptable to the board and adopted by the applicant within the
				preceding five (5) years is not on file with the board;
8.2.2. The applicant is a health care
				facility subject to the financial disclosure provisions of W. Va. Code
				'16-5F-1 et seq. or W.
				Va. Code '16-29B-1
				et seq., and the health care facility has failed to file with the board all
				reports, records, data or other information required by the Code.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-20 - Conversion Of Acute Care Beds To Skilled Nursing Care Beds › Section 65-20-9 - Stays and Extensions of Review Periods

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. At any time during the board's review of
				an application, the board may grant the applicant's request that the running of
				the review period be stayed. An application under review and stayed at the
				request of the applicant for a total period exceeding one hundred eighty (180)
				days during any review period shall be considered withdrawn, and a new letter
				of intent and application must be filed if the applicant desires to pursue the
				project.
9.2. Upon a finding by the
				board that it would not be practicable to complete the review of an application
				within the time provided by this rule, the board may extend the review process
				for up to an additional thirty (30) days. All applications within the batching
				category that are in the same review cycle shall be similarly
				extended.
9.3. Situations which
				would make it impracticable for the board to complete its review within the
				time provided by this rule include, but are not limited to the following:
9.3.1. A project is of such a comprehensive
				nature that to review it within the time provided by the rule would not do
				justice to the applicant or to the population which the proposed project would
				serve;
9.3.2. Additional
				information has been requested from the applicant and the applicant has failed
				to provide the information to the board in the time frame directed by the
				board; and
9.3.3. Weather
				conditions or other natural disasters have prevented the review process from
				taking place in a timely manner.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes the criteria and standards for certificate of need review for
				the development of life care retirement centers as provided by W. Va. Code
				'16-2D-5(j).
1.2. Authority. -- W. Va. Code ''16-2D-5(j),
				16-2D-8.
1.3. Filing Date. -- April
				10, 1992.
1.4. Effective Date. --
				April 10, 1992.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule implements certain provisions of Enrolled Committee
				  Substitute for House Bill 2194 which was passed by the Legislature on March 6,
				  1991, and was signed by the Governor on March 20, 1991. The bill created a new
				  subsection, W. Va. Code '16-2D-5(j).
				  This subsection authorizes the Health Care Cost Review Authority to promulgate
				  rules for the certificate of need review of applications for the development of
				  life care retirement centers.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in these regulations, all terms have the same meaning
				  as provided in the definition section of W. Va. Code '16-2D-2. Definitions
				  in this section amplify and clarify the statutory definitions or define terms
				  not specifically set forth in the statute.
3.1. Life care retirement center. -- A
				residential center that provides independent living, congregate housing
				facilities and a long term care nursing unit which is certified only for
				medicare skilled beds and is designed to provide a continuum of health and
				social services exclusively to its residents.
3.2. Skilled nursing bed. -- A long-term care
				bed designate as a SNF (skilled nursing facility bed) and certified as such
				under Medicare Title XVIII reimbursement.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-4 - Application

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. An application
				for a certificate of need shall be on forms approved by the board. The original
				and three (3) copies of the application must by submitted to the board. The
				application must be verified under oath by the Chief Executive
				Officer.
4.2. Application required
				for Certificate of Need. -- Information required for the application includes
				the following:
4.2.1. The identification of
				the applicant;
4.2.2. An
				authorization to pursue the project;
4.2.3. A description of the
				project;
4.2.4. A timetable for the
				implementation of the project;
4.2.5. An analysis of the need for the
				project;
4.2.6. The policies for
				patient admission and eligibility criteria;
4.2.7. An analysis of alternatives to the
				projects;
4.2.8. An analysis of
				competitive factors;
4.2.9. The
				relationship of the project to licensure, certification, accreditation and
				safety standards;
4.2.10. The
				availability of resources and manpower;
4.2.11. A preliminary financial feasibility
				study - the applicant must demonstrate that the proposed project is financially
				feasible and at a minimum provide the following:
4.2.11.a. Statements of (a) revenues and
				expenses, (b) balance sheet, (c) statement of changes in fund balances, and (d)
				statement of cash flow for the last two years if available. Audited financial
				statements shall be submitted, if available;
4.2.11.b. A preliminary financial feasibility
				study and cash flow statements for the proposed life care retirement center for
				a three (3) year period including, at a minimum, pro forma financial statements
				for the first three (3) years along with all assumptions upon which the
				projections were based.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-5 - Additional Information or Amendments to Application

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. After the review of an application has
				begun, the board may require the applicant to submit additional information. If
				no hearing is requested upon the application, and the applicant fails to submit
				the information within the time directed, or if the applicant submits a
				substantial amendment to its application, the board may:
5.1.1. Extend the review cycle pursuant to
				the provisions of 65 CSR 7, section 13;
5.1.2. Enter an order closing the file ten
				(10) days from the entry of such order; or
5.1.3. Withdraw the application from
				review.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-6 - Application Withdrawal

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. An
				application under consideration by the board may be withdrawn by the applicant
				at any time prior to the issuance of a final decision and written findings. The
				withdrawal of the application is without prejudice.
6.2. A written notice withdrawing the
				application must be filed with the board before the issuance of a final
				decision.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-7 - Batching of Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. All
				applications shall be batched in the appropriate batching category pursuant to
				65 CSR 7, section 10.
7.2.
				Applications will be reviewed in four (4) annual cycles. On the first Friday of
				the months of February, May, August and November, the board will collect by
				batching categories all applications determined to be complete since the
				previous cycle. The board shall then establish a ninety (90) day review cycle
				for each category. For consideration in any batch cycle, the application must
				be submitted no later than fifteen (15) days prior to the beginning of the
				batch.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-8 - Application Review Procedure

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1.
				Applicants must file a letter of intent with the board at least fifteen (15)
				days before the submission of a formal application. The letter of intent must
				contain sufficient information to advise the board of the nature, scope, cost
				and timing of the project, as well as the location and name of the proposed
				applicant. Letters of intent are effective for one (1) year from the date of
				their filing.
8.2. Upon receipt of
				a certificate of need application, the board shall determine whether the
				application is complete or whether additional information is required. A
				declaration by the board that an application is complete means that there is
				sufficient information contained in the application for the board to make an
				informed decision. It does not mean that the approval of the application is
				warranted. Except in emergency situations that pose a threat to the public
				health, an application shall not be declared complete if:
8.2.1. A long-range plan with a sufficient
				level of detail acceptable to the board and adopted by the applicant within the
				preceding five (5) years is not on file with the board;
8.2.2. The applicant is a health care
				facility subject to the financial disclosure provisions of W. Va. Code
				'16-5F-1 et seq., or W.
				Va. Code '16-29B-1
				et seq., and the health care facility has failed to file with the board all
				reports, records, data or other information required by the Code.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-9 - Stays and Extensions of Review Periods

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. At any time during the board's review of
				an application, the board may grant the applicant's request that the running of
				the review period be stayed. An application under review and stayed at the
				request of the applicant for a total period exceeding one hundred eighty (180)
				days during any review period is considered withdrawn, and a new letter of
				intent and application must be filed if the applicant desires to pursue the
				project.
9.2. Upon a finding by the
				board that it would not be practicable to complete the review of an application
				within the time provided by this rule, the board may extend the review process
				for up to an additional thirty (30) days. All applications within the batching
				category that are in the same review cycle shall be similarly
				extended.
9.3. Situations which
				would make it impracticable for the board to complete its review within the
				time provided by this rule include, but are not limited to the following:
9.3.1. A project is of such a comprehensive
				nature that to review it within the time provided by this rule would not do
				justice to the applicant or to the population which the proposed project would
				serve;
9.3.2. Additional
				information has been requested from the applicant and the applicant has failed
				to provide the information to the board in the time frame directed by the
				board; and,
9.3.3. Weather
				conditions or other natural disasters have prevented the review process from
				taking place in a timely manner.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-21 - Development Of Life Care Retirement Centers › Section 65-21-10 - Criteria and Standards

Current through Register Vol. XLI, No. 28, July 12, 2024
Statement of Purpose: In order to ensure an appropriate
				  supply of health services to the citizens of West Virginia while discouraging
				  unnecessary duplication and high costs, the Health Care Cost Review Authority
				  shall conduct a thorough public review and evaluation of proposed
				  projects.s
The goal of the Certificate of Need Program is to provide for
				  the continued orderly development of the health care system in West Virginia
				  through a public review of proposed applications that are evaluated in
				  accordance with established Criteria and Standards. The purpose of the Criteria
				  and Standards is twofold:
(1) To serve as guidelines in the continued orderly
				  development of the health care system in West Virginia in accordance with the
				  Certificate of Need statute; and
(2) To promote cost-effective alternatives to higher-cost
				  services.
10.1. On a statewide basis,
				a maximum of one hundred eighty (180) long term care beds may be developed in
				conjunction with the development of life care retirement centers. The long term
				care beds shall be certified only as medicare skilled nursing beds.
10.2. There shall be minimum of twenty (20)
				beds and a maximum of sixty (60) long term care nursing beds in each approved
				life care retirement center.
10.3.
				The life care retirement center shall meet all federal and state licensing
				certification and operational requirements applicable to nursing
				homes.
10.4. The life care
				retirement center must demonstrate a need for the project:
10.4.1. The applicant must demonstrate a need
				or demand for the life care retirement center through a market analysis that
				targets specific populations.
10.4.2. The applicant must demonstrate a need
				for the number of nursing care beds proposed exclusively for use by the
				residents of the life care retirement center.
10.4.3. The number of proposed nursing care
				beds must bear a reasonable relationship to the number of residents of the life
				care retirement center.
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 65-22-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes a process for obtaining temporary approval, subject to
				retroactive review, of discount contracts for border hospitals under certain
				limited circumstances.
1.2.
				Authority. -- W. Va. Code ''16-29B-8(a)(1), 19a and 20.
1.3. Filing Date. -- June 24, 1993.
1.4. Effective Date. -- June 24,
				1993.
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 65-22-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule addresses a problem identified in the report
				  prepared by the Health Care Cost Review Authority pursuant to the provisions of
				  W. Va. Code '16-29B-19a
				  relating to border hospital and discount contracts. This rule is intended to
				  allow border hospitals seeking approval of proposed discount contracts pursuant
				  to W. Va. Code '16-29B-20
				  to obtain temporary approval subject to retroactive review by the Authority,
				  upon the filing of certain information with the Authority as set forth in this
				  rule and under certain limited circumstances as set forth in this rule. The
				  report prepared by the Health Care Cost Review Authority pursuant to W. Va.
				  Code '16-29B-19a indicated
				  that certain border hospitals may face a loss of patients to nearby
				  out-of-state hospitals which are not regulated regarding discount contracts,
				  such that out-of-state hospitals may immediately implement discount contracts.
				  Out-of-state hospitals may obtain a competitive advantage over border hospitals
				  by having access to the information submitted to the Authority related to
				  discount contracts for border hospitals in certain circumstances in which the
				  border hospital could not obtain similar information for out-of-state hospitals
				  which are not regulated regarding discount contracts. This rule is intended to
				  prevent border hospitals in a limited geographic area from being at a
				  competitive disadvantage to out-of-state hospitals due to the necessity of
				  obtaining approval from the Authority of discount contracts with the rate
				  application under W. Va. Code '16-29B-20. This rule
				  is intended to allow border hospitals to temporarily obtain approval of
				  discount contracts, subject to retroactive approval by the Authority in
				  accordance with W. Va. Code '16-29B-20.
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 65-22-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, all terms have the same meaning as
				  provided in section two of the Act. Terms not defined in the Act have the
				  following meanings except where the context may expressly require
				  otherwise.
3.1. "Authority" means the
				West Virginia Health Care Cost Review Authority, an autonomous division of the
				West Virginia Department of Health and Human Services.
3.2. "Act" means the West Virginia Health
				Care Cost Review Authority Act, W. Va. Code '16-29B-1
				et seq.
3.3. "Interested party"
				means any individual, group or organization which files a written request with
				the Authority on or before the prehearing conference stating that the
				individual, group or organization is aggrieved or is likely to be aggrieved
				based upon information and belief by any act or failure to act by the Authority
				or by any rule, regulation or final order of the Authority and setting forth
				with particularity the basis for the request.
3.4. "Affected party" means any interested
				party which is recognized by the Authority as an affected party.
3.5. "Code" means the Code of West Virginia
				of 1931, as amended.
3.6. "Border
				hospital" means a hospital located in the State of West Virginia which is
				located within ten (10) miles of an out-of-state hospital having a similar
				number of beds and a similar array of services as the West Virginia
				hospital.
3.7. "Discount contract"
				means any contract for the payment of patient care services between a purchaser
				or third party payor and a hospital which establishes discounts to the
				purchaser or third party payor and which is subject to the approval of the
				Authority pursuant to W. Va. Code '16-29-20. Examples of discount contracts
				include, but are not limited to, (1) written contracts between a hospital and a
				third party payor or purchaser establishing a discount to the payor or
				purchaser in the form of a percentage reduction in the amount of charges, (2)
				other adjustments that have the effect of decreasing the amount of charges and
				(3) informal arrangements between hospitals and purchasers or third party
				payors which have the effect of decreasing the amount of charges for a group of
				patients.
3.8. "Verified notice"
				means a notice which contains all of the facts and information required by this
				rule and which has attached to it a statement made under oath before a notary
				public or other official entitled to administer oaths in West Virginia by the
				chief executive officer of the border hospital that the facts and circumstances
				set forth in the notice are true, accurate and complete to the best knowledge
				of the chief executive officer.
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 65-22-4 - Temporary Approval

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A
				border hospital may obtain temporary approval of a proposed discount contract
				subject to retroactive review by the Authority, if each of the following
				conditions is met.
4.1.1. The border hospital
				is located within ten (10) miles of an out-of-state hospital which has a
				similar number of beds and a similar array of services as the border hospital;
				and
4.1.2. The border hospital
				files a verified notice with the Authority, which notice meets the requirements
				described in section 5 of this rule.
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 65-22-8 - Final Order; Requests for Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. An order by the Authority temporarily
				approving or temporarily denying a proposed discount contract in accordance
				with this rule is not a final decision under W. Va. Code '16-29B-13,
				and only an order denying or approving the proposed discount contract in the
				regular rate review procedure as set forth in W. Va. Code ''16-29B-20 and 21 is
				a final decision under W. Va. Code '16-29B-13.
8.2. Any affected person may request the
				Authority to conduct an administrative hearing in connection with the final
				approval or final denial of a proposed discount contract as set forth in
				subsection 7.1 of this rule by filing a written request for an administrative
				hearing with the Authority within ten (10) days after the date of the final
				order.
8.3. The Authority shall
				conduct the administrative hearing within thirty (30) days of the filing of the
				request for an administrative hearing unless upon a showing of good cause or by
				mutual agreement of all parties to the proceeding the Authority establishes a
				later date.
8.4. At the conclusion
				of the administrative hearing, the parties shall submit proposed findings of
				fact and conclusions of law or legal briefs if required by the
				Authority.
8.5. The Authority may
				conduct a prehearing conference in accordance with Rule 16 of the West Virginia
				Rules of Civil Procedure. If an order is first obtained from the Authority, the
				parties may engage in discovery as provided by the West Virginia Rules of Civil
				Procedure.
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 65-22-9 - Appeal

Current through Register Vol. XLI, No. 28, July 12, 2024
Only final orders issued by the Authority as defined in
				  subsection 7.1 of this rule approving or denying the proposed discount contract
				  under the criteria set forth in W. Va. Code '16-29B-20, pursuant to
				  the retroactive review described in section six of this rule are a final
				  decision of the Authority for the purpose of appeals under W. Va. Code
				  '16-29B-13;
				  otherwise, a temporary order approving or denying the proposed discount
				  contract under this rule is not a final decision for the purpose of appeals
				  under W. Va. Code '16-29B-13.
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 65-22-10 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any section or provision of this rule is declared
				  unconstitutional or void by any court of competent jurisdiction, or the
				  applicability of this rule is held invalid as it relates to a particular person
				  or persons or a particular circumstance, the constitutionality or validity of
				  the remainder of this rule shall not be affected thereby and, to this end, the
				  sections and provisions of this rule are severable.
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 65-23-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule establishes an exemption from certificate of need review for
				certain primary care services.
1.2.
				Authority. -- W. Va. Code ''16-2D-4(a)(5) and 8.
1.3. Filing Date. -- June 24, 1993.
1.4. Effective Date. -- June 24,
				1993.
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 65-23-3 - Exemption Criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. To
				qualify for an exemption from certificate of need review for the creation of
				new primary care services the applicant must meet the following criteria:
3.1.1. The applicant must be a
				community-based primary care organization;
3.1.2. The applicant must propose to provide
				new primary care services which services must be available to the public within
				one year from the date the exemption application is filed with the Authority;
				and
3.1.3. The proposed new primary
				care services must be located in an underserved community and the services must
				be available to people without regard to ability to pay.
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 65-23-5 - Requests for Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. If
				an affected person requests a hearing, the board shall terminate the exemption
				review period. The board or its designee shall hold a hearing within thirty
				(30) days of the request for a hearing unless the board sets a later date upon
				a showing of good cause.
5.2. The
				board or its designee may conduct a prehearing conference in accordance with
				Rule 16 of the West Virginia Rules of Civil Procedure. If an order is first
				obtained from the board or a hearing examiner appointed by it, the parties may
				engage in discovery as provided by the West Virginia Rules of Civil Procedure;
				except that the scope of discovery is limited to relevant and admissible
				evidence.
5.3. At the conclusion of
				the hearing, the parties may submit proposed findings of fact, conclusions of
				law, and legal briefs. The board has ten (10) days from the receipt of those
				items or the closure of the record if those items are not tendered to make its
				determination in writing.
5.4. A
				written decision made pursuant to subsection 5.3 of this rule is a final
				decision. The board shall publish notice of the decision in the Saturday
				Charleston newspapers and the State Register.
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 65-23-6 - Competing Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
If two (2) or more applications which involve part or all of
				  the same service area are received by the board within thirty (30) days of one
				  another, the Office of Community and Rural Health Services shall advise the
				  board whether each applicant would be eligible in the absence of the competing
				  application. If both applicants are eligible, the board shall determine which
				  applicant shall receive the exemption.
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 65-23-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
The provisions of this rule are severable. If any portion of
				  this rule is held invalid, the remaining provisions remain in
				  effect.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-24 - Exemption For Birthing Centers › Section 65-24-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule establishes an exemption from certificate of need review for
				birthing centers in areas that are underserved with respect to low-risk
				obstetrical services.
1.2.
				Authority. -- W. Va. Code ''16-2D-4(a)(6) and 8.
1.3. Filing Date. -- June 24, 1993.
1.4. Effective Date. -- June 24,
				1993.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-24 - Exemption For Birthing Centers › Section 65-24-3 - Exemption Criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. To
				qualify for the exemption from certificate of need review for a birthing center
				the applicant must meet the following criteria:
3.1.1. The applicant must be an eligible
				primary care center or an eligible hospital;
3.1.2. The proposed birthing center shall be
				located in an underserved service area.
3.1.3. The applicant must meet all state
				licensure requirements prior to the provision of services.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-24 - Exemption For Birthing Centers › Section 65-24-5 - Requests for Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. If
				an affected person requests a hearing, the board shall terminate the exemption
				review period. The board or its designee shall hold a hearing within thirty
				(30) days of the request for a hearing unless the board sets a later date upon
				a showing of good cause.
5.2. The
				board or its designee may conduct a prehearing conference in accordance with
				Rule 16 of the West Virginia Rules of Civil Procedure. If an order is first
				obtained from the board or a hearing examiner appointed by it, the parties may
				engage in discovery as provided by the West Virginia Rules of Civil Procedure;
				except that the scope of discovery is limited to relevant and admissible
				evidence.
5.3. At the conclusion of
				the hearing, the parties may submit proposed findings of fact, conclusions of
				law, and legal briefs. The board has ten (10) days from the receipt of those
				items or the closure of the record if those items are not tendered to make its
				determination in writing.
5.4. A
				written decision made pursuant to subsection 5.3 of this rule is a final
				decision. The board shall publish notice of the decision in the Saturday
				Charleston newspapers and the State Register.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-24 - Exemption For Birthing Centers › Section 65-24-6 - Competing Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
If, within thirty (30) days of one another, an eligible
				  primary care center and an eligible hospital which are located in the same
				  county file applications pursuant to this rule, then at least one primary care
				  center and at least one hospital from the county shall be required to
				  collaborate for the provision of services at a birthing center in order to
				  qualify for this exemption. Otherwise, if more than one application is received
				  for this exemption for the same or overlapping underserved service areas as
				  determined by the board, then no exemption shall be issued, and the birthing
				  centers shall be subject to certificate of need review.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-24 - Exemption For Birthing Centers › Section 65-24-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
The provisions of this rule are severable. If any portion of
				  this rule is held invalid, the remaining provisions remain in
				  effect.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule creates a mechanism for a rural primary care hospital (RPCH)
				to reject designation as a RPCH within twenty-four (24) calendar months from
				the date of such designation, and thereby restore its previously staffed and
				operated acute care beds without obtaining a certificate of need.
1.2. Authority. -- W. Va. Code ''16-2D-4(g)
				and 8.
1.3. Filing Date. -- June
				24, 1993.
1.4. Effective Date. --
				June 24, 1993.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Board -- The
				West Virginia Health Care Cost Review Authority which is designated to
				administer the Certificate of Need Program pursuant to W. Va. Code
				'16-29B-11.
2.2. Rural Primary Care Hospital (RPCH) -- A
				rural primary care hospital (RPCH) is a hospital that provides inpatient
				services, and/or stabilization before discharge or transfer to an essential
				access community hospital (EACH). The RPCH has a limited number of acute care
				beds with an additional limitation on the number of days a patient can be
				considered an inpatient. RPCH's must be designated as such by the West Virginia
				Office of Rural Health Policy in accordance with the guidelines established in
				W. Va. Code '16-2D-4(g).
2.3. State Agency -- Health Care Cost Review
				Authority.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-3 - Exemption Criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
To qualify for the exemption from certificate of need review
				  a rural primary care hospital must meet the following criteria:
3.1. The hospital must be designated as a
				RPCH by the Office of Rural Health Policy.
3.2. The hospital must undergo a reduction in
				its licensed acute care beds as determined by the Office of Rural Health
				Policy.
3.3. The Office of Rural
				Health Policy shall notify the Health Care Cost Review Authority of the
				hospital's designation as a RPCH; the number of beds staffed and operated by
				the hospital immediately prior to designation; and the number of acute care
				beds certified by the Health Care Financing Administration.
3.4. The hospital must reject the designation
				as a RPCH within twenty-four (24) calendar months from the date of designation
				by the Office of Rural Health Policy by written notice to the Office of Rural
				Health Policy and the Health Care Cost Review Authority.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-4 - 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
				(15th) day or later than the thirtieth (30th) 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, 3.2, 3.3,
				and 3.4 of this rule.
4.3.2.
				Information regarding the number and type of beds which the applicant seeks to
				restore; provided that the total number of beds which the hospital proposes to
				license shall not exceed the number of beds which were staffed and operated by
				the hospital immediately prior to the hospital's designation as a
				RPCH.
4.3.3. A verification signed
				by the chairperson of the hospital's board and the hospital's chief executive
				officer.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-5 - Requests for Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. If
				an affected person requests a hearing, the board shall terminate the exemption
				review period. The board or its designee shall hold a hearing within thirty
				(30) days of the request for a hearing unless the board sets a later date upon
				a showing of good cause.
5.2. The
				board or its designee may conduct a prehearing conference in accordance with
				Rule 16 of the West Virginia Rules of Civil Procedure. If an order is first
				obtained from the board or a hearing examiner appointed by it, the parties may
				engage in discovery as provided by the West Virginia Rules of Civil Procedure;
				except that the scope of discovery is limited to relevant and admissible
				evidence.
5.3. At the conclusion of
				the hearing, the parties may submit proposed findings of fact, conclusions of
				law, and legal briefs. The board has ten (10) days from the receipt of those
				items or the closure of the record if those items are not tendered to make its
				determination in writing.
5.4. A
				written decision made pursuant to subsection 5.3 of this rule is a final
				decision. The board shall publish notice of the decision in the Saturday
				Charleston newspapers and the State Register.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-6 - Notification By Office of Rural Health Policy

Current through Register Vol. XLI, No. 28, July 12, 2024
Within twenty-five (25) months from its designation of rural
				  primary care hospitals, the Office of Rural Health Policy shall notify the
				  board of the status of the designated hospitals including the number of
				  licensed beds for each designated hospital.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-25 - Exemption For Rural Primary Care Hospitals › Section 65-25-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
The provisions of this rule are severable. If any portion of
				  this rule is held invalid, the remaining provisions remain in
				  effect.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes an alternative rate setting system and a discount contract
				review for acute care hospitals in West Virginia.
1.2. Authority. -- W. Va. Code
				''16-29B-8(a)(1), 19, 19a and 20.
1.3. Filing Date. -- April 25,
				2005.
1.4. Effective Date. -- April
				25, 2005.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Act - The West
				Virginia Health Care Authority Act, W. Va. Code §
									16-29B-1
				et seq.
2.2. Affected party - Any
				interested party which is recognized by the Authority as an affected
				party.
2.3. Authority - Health Care
				Authority.
2.4. CMI - Case Mix
				Index which is an index determined by multiplying the respective DRG weights in
				effect at the time of the discharges by the number of discharges for each DRG
				weight classification in order to arrive at a weighted DRG for each DRG
				classification. The DRG classifications are then added together and divided by
				the total number of discharges for the hospital to arrive at a case mix index
				for the respective category of payors, all as determined by the Authority based
				upon information submitted by the hospital and other sources of
				information.
2.5. DRG - Diagnosis
				related group which is a relative measure of resources used to treat
				inpatients.
2.6. DRI - Inflation
				factor entitled the "New CMS Hospital Prospective Reimbursement Market Basket"
				published in Global Insight's DRI/WEFA Health Care Cost Review.
2.7. IME factor - Indirect medical education
				factor as developed by the Authority.
2.8. Interested party - Any individual, group
				or organization which files a written request with the Authority on or before
				the prehearing conference date stating that the individual, group or
				organization is aggrieved or is likely to be aggrieved based upon information
				and belief by any act or failure to act by the Authority or by any rule or
				final order of the Authority and setting forth with particularity the basis for
				the request.
2.9. Weighted Average
				Case Mix Index - In computing the average CMI for peer grouping purposes, the
				DRG case weight for discharges is included at twice the value over the prior
				year. The Authority will use the most recent four (4) years for which it has
				complete data when calculating the weighted average case mix index.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-3 - Overview

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. This rule
				establishes a benchmarking process for setting average nongovernmental rates
				for acute care hospitals in West Virginia. Benchmarking simplifies the rate
				setting process and makes it less burdensome for hospitals to file rate
				applications. Hospitals receive an automatic adjustment to their rates under
				the benchmarking system. Hospitals with lower costs and charges receive a
				higher rate of increase under the benchmarking model.
3.2. This rule also establishes the criteria
				and review process for the approval of discount contracts for the payment of
				patient care services between a purchaser or third-party payer and a
				hospital.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-4 - Calculation of Benchmark Rankings

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The Authority shall calculate the
				benchmark rankings on an annual basis and inform all hospitals subject to rate
				review of their rankings and the increase for which they are eligible using the
				benchmark review. The Authority shall update the rankings annually using data
				of record on July 1 of each year. The Authority shall also annually adjust the
				thresholds for outliers by DRI.
4.2. Hospitals which have not submitted
				accurate or complete information, including uniform billing and financial
				disclosure data, are not eligible for the benchmarking rate review process.
				However, if the failure to submit complete and accurate data is determined by
				the Authority to be due to problems associated with the Authority's data
				contractor, then data from an earlier period, appropriately price leveled, may
				be used for the hospital's benchmark. The calculation of the benchmarks shall
				use all discharges for all payors.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-5 - Peer Groups and the Variables of the Benchmark Ranking Process

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Peer Groups.
				The Authority shall divide the hospitals into three peer groups for the initial
				year:
(1) Hospitals with a weighted average
				CMI greater than 1.300 or with a Level I or Level II trauma center designation
				from the Office of Health Facility Licensure and Certification;
(2) hospitals with a weighted average CMI of
				1.050 to 1.300; and
(3) hospitals
				with a weighted average CMI of less than 1.050.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-26 - Benchmarking And Discount Contract Rule › Section 65-26-6 - Allowed Adjustments

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Adjustments in a hospital's average nongovernmental inpatient charge per
				discharge shall be determined based upon the hospital's ranking in its peer
				group . The hospital shall be ranked within its peer group based upon two
				variables:
(1) inpatient charge per
				dischargeand
(2) inpatient cost per
				discharge. The Authority shall calculate the adjustments using the hospital's
				projected actual nongovernmental charge per discharge.