reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-04 - Legislative Rules To Implement Utilization Review And Quality Assurance Program - Phase 1 › Section 65-4-6 - Sanctions

Current through Register Vol. XLI, No. 28, July 12, 2024
Any person or persons who violate or refuse to comply with
				  the requirements of these rules shall be subject to remedial action as provided
				  for under the Act including criminal penalties as provided for by West Virginia
				  Code section twenty-seven, article twenty-nine-b, chapter sixteen, orders of
				  enforcement as provided for by West Virginia Code section fifteen, article
				  twenty-nine-b, chapter sixteen, civil actions as provided for by West Virginia
				  Code section fourteen, article twenty-nine-b, chapter sixteen, and such other
				  sanctions as are reasonably necessary or essential to effect the express
				  objectives and purposes of the Act as provided for by West Virginia Code
				  subdivision (6), subsection (a), section eight, article twenty-nine-b, chapter
				  sixteen.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-04 - Legislative Rules To Implement Utilization Review And Quality Assurance Program - Phase 1 › Section 65-4-7 - Phase 2

Current through Register Vol. XLI, No. 28, July 12, 2024
These rules cover only Phase 1 of the Authority's program
				  under Section 23 (a) of the Act. Phase 2 of the program will consist of the
				  implementation of the provisions of Section 23 (b) and (c) of the Act. Phase 2
				  will be developed following the collection of this initial data and following
				  the required hearings.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-04 - Legislative Rules To Implement Utilization Review And Quality Assurance Program - Phase 1 › Section 65-4-8 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision or provisions of these rules or the
				  application thereof to any person or circumstance shall be held invalid, such
				  invalidity shall not affect the provisions or applications of these rules which
				  can be given effect without the invalid provision or provisions or application
				  and to this end the provisions of these rules are declared to be
				  severable.
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 65-5-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes a cost-based rate review system for acute care hospitals in
				West Virginia.
1.2. Authority. --
				W. Va. Code ''16-29B-19a, 20(j) and 20(k).
1.3. Filing Date. -- March 29,
				1993.
1.4. Effective Date. -- April
				29, 1993.
1.5. Repeal of Former
				Rule. -- This rule repeals and replaces the "Procedural Rule for Requests for
				Hospital Rate Changes," 65 C.S.R. 3, the "Hospital Cost Containment Methodology
				- Phase 1," 65 C.S.R. 5, the "Review For Automatic Rate Changes," 65 C.S.R. 19,
				and the "Expedited Review For Rate Changes," 65 C.S.R. 14.
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 65-5-2 - Introduction

Current through Register Vol. XLI, No. 28, July 12, 2024
This legislative rule which is exempt from legislative review
				  implements certain provisions of Enrolled Committee Substitute for House Bill
				  2194 which was passed by the Legislature on March 6, 1991, effective from
				  passage, and was signed by the Governor on March 20, 1991. This bill created a
				  new Code section, W. Va. Code '16-29B-19a, which
				  directs the board of the Health Care Cost Review Authority to develop a
				  cost-based rate review system and to adopt regulations to implement the
				  cost-based rate review methodology by July 1, 1992.
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 65-5-5 - Full Financial Requirements (FFR)

Current through Register Vol. XLI, No. 28, July 12, 2024
The first step in the calculation of a hospital specific rate
				  is the identification of the full financial requirements (FFR) of each hospital
				  in its base years. FFR can be defined as the total revenue needed from all
				  services by a hospital to maintain financial viability. The components of FFR
				  include, but are not limited to, total operating expenses, capital related
				  costs (i.e., depreciation, interest expense, insurance, property taxes, leased
				  equipment costs, etc), charity, bad debts, interest on short term loans for
				  working capital, and a fair return on invested capital. The Authority assumes
				  that hospitals budget for their needs, including the need for working
				  capital.
5.1. Operating Expenses
5.1.1. Operating Expenses shall include, but
				not be limited to the following:
5.1.1.a.
				Non-supervisory salaries, wages and benefits; [Will remain subject to pass
				through pursuant to W. Va. Code '16-29B-20(d)];
5.1.1.b. Supervisory salaries and
				wages;
5.1.1.c. Employee
				benefits;
5.1.1.d. Consumable
				supplies such as, office supplies; food and dietary supplies; medical supplies,
				both consumable and saleable; pharmacy supplies, both consumable and saleable;
				laundry supplies; etc;
5.1.1.e.
				Other expenses such as, employee recruitment expense, travel expense, education
				expense other than medical education expense, etc;
5.1.1.f. Utilities, including energy, water,
				telephone and waste disposal.
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 65-5-7 - Temporary/Emergency Rate Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. A hospital is eligible to obtain a
				temporary change in its rates if it is in the public interest and it is
				necessary:
a) to prevent insolvency,
b)to maintain
				accreditation,
c)for emergency
				repairs, or
d)to relieve undue
				financial hardship.
To qualify for a temporary change in its rates, a hospital
				  shall submit an application to the Authority which addresses the above
				  described criteria, describes in detail the facts which support the temporary
				  rate change, the amount of increase in rates required to alleviate its
				  situation, and shall summarize the overall effect of the rate increase. The
				  claim shall be verified by the chairman of the hospital's governing body and or
				  by the chief executive officer of the hospital.
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 65-5-10 - Overages

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. Patient
				Revenue Limits:
The Authority establishes several limits during the rate
				  setting process. The limits currently established are listed below. These
				  categories are subject to change by amendment to this rule when refinements are
				  made to the cost-based rate review system.
10.1.1. Acute Care Hospital
10.1.1.a. Gross inpatient revenue per
				day
10.1.1.b. Gross inpatient
				revenue per discharge
10.1.1.c.
				Gross inpatient acute care revenue
10.1.1.d. Outpatient revenue per
				visit
10.1.1.e. Gross outpatient
				revenue
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 65-5-11 - Penalties For Overages

Current through Register Vol. XLI, No. 28, July 12, 2024
Unjustified overages are subject to penalties which may be
				  imposed by the Authority. The penalty, in the discretion of the Authority, may
				  be a direct payment or rebate to third-party payors and/or purchasers or it may
				  be a reduction in the hospital's future rates. Generally, penalties shall be in
				  effect during the hospital's next fiscal year or for a period of twelve months
				  unless the overage is such that a longer time period is
				  required.
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 65-5-12 - Cost Base Adjustments

Current through Register Vol. XLI, No. 28, July 12, 2024
The Authority recognizes that costs continue to increase due
				  to salary increases and increases in the cost of items the hospitals must
				  purchase. It is inherent in this rule that actual costs and costs projected on
				  the inflation factor will grow wider over time. Therefore, the Authority will
				  rebase the costs periodically as necessity requires.
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 65-5-13 - New Service

Current through Register Vol. XLI, No. 28, July 12, 2024
The hospital must apply to the Authority for approval of a
				  rate schedule for a new service. Announcement of the approved rate schedule
				  must be made by the hospital to the local media in the geographic location of
				  the hospital. The publication must state that approved rates will go into
				  effect in thirty (30) days. Affected parties may contest the proposed rate by
				  written notice to the Authority within two (2) weeks from the date of
				  publication.
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 65-5-14 - Request for Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
The hospital or an interested party may request a public
				  hearing to be held on an application. A request for a public hearing must be
				  received by the Authority within thirty (30) days of the receipt by the
				  Authority of the application or the publication of the legal advertisement as
				  required by subsections 6.7 or 9.4 whichever is later. The Authority, if it
				  considers necessary, may hold a public hearing on any application. Such hearing
				  shall be held no later than forty-five (45) days after receipt of the
				  application unless good cause is shown to hold the hearing at a later
				  date.
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 65-5-15 - Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
The hearing shall be conducted pursuant to the provisions of
				  W. Va. Code '16-29B-12.
				  The Authority may appoint a hearing examiner to conduct the hearing. The
				  Authority or the hearing examiner may schedule and require attendance at a
				  prehearing conference. The purposes of the prehearing conference shall be
				  similar to the purposes of Rule 16, West Virginia Rules of Civil Procedure.
				  Affected parties will be designated by the Authority at the prehearing
				  conference unless good cause is shown by the party for the Authority to
				  designate affected party status at the hearing.
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 65-5-16 - Reconsideration

Current through Register Vol. XLI, No. 28, July 12, 2024
If a hospital or affected party wants the Authority to
				  reconsider a final order, it shall file its request in writing and shall detail
				  the reasons for the request for reconsideration. The Authority shall consider
				  the following as reasons to grant a request for reconsideration:
a) a presentation of significant, relevant
				information not previously considered by the Authority, and a demonstration
				that with reasonable diligence the information could not have been presented
				before the Authority issued its final order;
b)a demonstration that there have been
				significant changes in factors or circumstances relied upon by the Authority in
				issuing its final order;
c)a
				demonstration that the Authority has materially failed to follow its adopted
				procedures in issuing its final order; or
d)such other bases as the Authority
				determines constitutes good cause. Provided that, the Authority will not grant
				a request for reconsideration based upon an insignificant or immaterial
				difference between the projected data in the hospital's application and its
				actual data. A request for reconsideration must be filed within thirty (30)
				days of the receipt of the final order by the requesting party. The Authority
				shall respond to the request for reconsideration in writing and shall state its
				reasons for granting or denying the request. The Authority is not required to
				hold a public hearing in every reconsideration proceeding. Instead, if the
				Authority determines that the issues do not involve a factual dispute or
				otherwise do not require the taking of further evidence upon the record, the
				Authority may issue its reconsideration decision without conducting a public
				hearing. In the event the Authority grants a reconsideration request but
				determines that a public hearing is not required, the Authority may enter
				additional evidence into the record by stipulation by the applicant and all
				affected parties. The one hundred eighty (180) day review period described in
				subsection 6.5 of this rule is not applicable to reconsideration
				proceedings.
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 65-5-17 - Appeals

Current through Register Vol. XLI, No. 28, July 12, 2024
A final decision of the Authority shall be reviewed by the
				  state agency designated by the governor to hear appeals pursuant to W. Va. Code
				  '16-2D-1 et
				  seq. To be effective, the request for review must be received within thirty
				  (30) days of the date upon which all parties received notice of the Authority's
				  decision.
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 65-5-18 - Rates During Reconsideration Proceedings and Appeals

Current through Register Vol. XLI, No. 28, July 12, 2024
If the Authority 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 and third-party payors
				  accordingly without in any way adversely affecting or waiving its right to
				  contest or appeal that portion of the final order of the Authority which denied
				  the remainder of the requested rate increase. Similarly, if an affected party
				  contests or appeals the final order of the Authority, the hospital may charge
				  its purchasers in accordance with the Authority's final order until the final
				  order is subsequently modified.
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 65-5-19 - Denial of an Application

Current through Register Vol. XLI, No. 28, July 12, 2024
The Authority may deny any application submitted by a
				  hospital pursuant to this rule if the application:
19.1. fails to pass the mathematical
				edit;
19.2. is materially
				inconsistent, inaccurate, or contains unreliable data;
19.3. is materially inconsistent with other
				financial data required to be filed by the hospital with the Authority pursuant
				to 65 C.S.R. 13, "The Financial Disclosure Rule";
19.4. is not submitted at least forty five
				(45) days prior to the beginning of the hospital's fiscal year;
19.5. contains material misrepresentations
				made by the hospital to the Authority; or
19.6. may otherwise be denied for good cause
				as determined by the Authority.
If the Authority denies an application, it may, in its
				  discretion, require the hospital to submit a new application within a specified
				  time period.
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 65-5-20 - Compliance Reports and Orders

Current through Register Vol. XLI, No. 28, July 12, 2024
Every hospital is required to file with the Authority a
				  compliance report within thirty (30) days after the end of each quarter of the
				  hospital's fiscal year. The information requested for the compliance report
				  will be provided by the hospital on forms to be provided by the Authority. If
				  the hospital fails to file the compliance report within thirty days after the
				  end of each quarter, the Authority may deny a request for a rate
				  increase.
If the fourth quarter compliance report indicates the
				  hospital has exceeded its approved revenue limits and does not provide a
				  justification which is accepted by the Authority, the Authority may order the
				  hospital to immediately reduce its rates by the amount of the
				  overage.
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 65-5-21 - Reasonableness and Uniformity of Rates

Current through Register Vol. XLI, No. 28, July 12, 2024
Hospital rates shall be reasonably related to the cost of the
				  services provided and uniformly applied to all patients whether inpatient or
				  outpatient.
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 65-5-23 - Failure to Comply with Rules

Current through Register Vol. XLI, No. 28, July 12, 2024
Failure by a hospital or an interested party to comply with
				  any of the requirements of these rules shall subject the hospital or the
				  interested party to sanctions including the possibility of denial of all
				  requested relief in an appropriate case. Failure by a hospital or an interested
				  party to comply with the time limits set forth in this rule may also, in the
				  discretion of the Authority, cause the time limits to be extended and the
				  failing party shall be deemed to have waived the time periods set forth in the
				  Act and these rules or the Authority may impose another appropriate
				  sanction.
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 65-5-24 - Health Care Facility Financial Disclosure Act

Current through Register Vol. XLI, No. 28, July 12, 2024
Before any application for a rate increase will be accepted
				  for review, the hospital must be in compliance with the Health Care Facility
				  Financial Disclosure Act, W. Va. Code, '16-5F-1 et seq.
				  Failure to be in such compliance shall cause the Authority to refuse to accept
				  the application or request and to reject it.
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 65-5-25 - Additional Information

Current through Register Vol. XLI, No. 28, July 12, 2024
If the Authority requires additional information from a
				  hospital or an interested party, then, in the discretion of the Authority, the
				  various time limits imposed by this rule shall be tolled until the requested
				  information is received by the Authority and the Authority determines the
				  response is sufficient.
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 65-5-26 - Time Periods

Current through Register Vol. XLI, No. 28, July 12, 2024
26.1. In
				each instance in this rule where a time period is stated, the period is
				intended to be a maximum period. In the event a given task is completed sooner
				than the stated period by the Authority, a hospital or an interested party,
				then the next time period, if any, shall commence upon the actual completion
				date.
26.2. Calculation of time
				periods. Whenever in this rule the date by which some action is directed to be
				taken or accomplished would fall on a Saturday, Sunday or a state holiday, then
				the time for taking or accomplishing the action shall be extended to the next
				day which is not a Saturday, Sunday or a state holiday.
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 65-5-27 - Decisions and Records Available

Current through Register Vol. XLI, No. 28, July 12, 2024
Decisions and records of the Authority may be inspected in
				  accordance with W. Va. Code '29B-1-3,
				  and may be copied at a charge of twenty-five cents ($.25) per
				  page.
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 65-5-28 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provisions of this rule or the application thereof to
				  any persons or circumstance shall be held invalid, such invalidity shall not
				  affect the provisions or applications of this rule which can be given effect
				  without the invalid provisions or application and to this end the provisions of
				  this rule are declared to be severable.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule implements the provisions of the cooperative agreement
				approval and compliance requirements of W. Va. Code §
									16-29B-28.
1.2. Authority. -- W. Va. Code §§
									16-29B-28(g) and
				16-29B-28(g)(1).
1.3. Filing Date. -- May 1, 2024.
1.4. Effective Date. -- May 1,
				2024.
1.5. This rule shall
				terminate and have no further force or effect on August 1, 2029.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The defined
				terms in W. Va. Code §
									16-29B-28(a) are
				incorporated by reference.
2.2. The
				following terms are defined:
2.2.1. "Health
				Care Authority" means the Health Care Authority created and continued pursuant
				to W. Va. Code §
										16-29B-1
et
				seq
.
2.2.2. "Secretary"
				means the Secretary of the Department of Health and Human Resources or his or
				her designee.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-3 - Annual Report

Current through Register Vol. XLI, No. 28, July 12, 2024
The annual report required by W. Va. Code §
									16-29B-28(g)(1)(A)
				  shall be submitted to the Secretary (a) on or before 120 days after the end of
				  the fiscal year of the qualified hospital participating in the cooperative
				  agreement or (b) upon written request of the qualified hospital participating
				  in the cooperative agreement, annually on the anniversary date on which closing
				  occurred on the merger, consolidation or acquisition.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-4 - Approval of Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Before finalization of a cooperative agreement involving the merger,
				consolidation, or acquisition of a hospital located within 20 highway miles of
				the main campus of the qualified hospital, an application for approval of a
				proposed cooperative agreement shall be submitted to the Health Care Authority
				at least 30 days prior to finalization.
4.2. Cooperative agreements that are not
				implicated by §65-6-4.1 of this rule may be submitted to the authority
				either before or after finalization.
4.3. The application shall state in detail
				the nature of the proposed arrangement, including the goals and methods for
				achieving all the elements set forth in W. Va. Code §
									16-29B-28(d)(3).
				If an application is determined to be incomplete, the applicant will be
				notified in writing of the additional information required.
4.4. Expedited decisions may be requested by
				filing a motion with the authority. If the authority has published the required
				notice of completeness, any affected person may present public comments
				regarding the application in writing within 10 days of the date the review
				begins. The authority shall then determine whether cause exists to require the
				applicant to use the standard application process. Otherwise, the authority
				shall close the file on the 31st day of the expedited review and issue a
				written decision.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-5 - Combination of Hospitals

Current through Register Vol. XLI, No. 28, July 12, 2024
Applicants approved to combine hospitals shall annually
				  disclose a representative sample of the most recent quality metrics published
				  by the Centers for Medicare and Medicaid Services selected by the authority for
				  each hospital participating in the collaborative agreement on a form prescribed
				  by the authority. This information shall be submitted at the same time as the
				  annual report required by W. Va. Code §
									16-29B-28(g)(1)(A)
				  for publication on the authority's web site.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-6 - Annual Report; Active Supervision

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				The authority shall utilize the Annual Report, as well as other information
				available to it, in performing the Active Supervision. The Annual Report shall
				include the following:
6.1.1. An explanation,
				with supporting documentation of its current compliance (or not) with each of
				the Terms and Conditions of the Cooperative Agreement Decision, that is
				certified by the Chief Executive Officer and Chief Financial Officer of the
				Applicant.
6.1.2. A summary of
				steps taken to reduce costs and improve efficiency;
6.1.3. An update on Population Health Plan
				and implementation achieved;
6.1.4.
				Any services that were consolidated during the year in review and the resulting
				cost savings in excess of $2,000,000;
6.1.5. Any material changes in volume or
				availability of any inpatient or outpatient services during the year in
				review;
6.1.6. A summary containing
				the number of approved resident positions for each residency program operated
				by the hospitals participating in the cooperative agreement and the number of
				such positions that are filled, along with copies of the relevant pages of the
				Medicare costs reports, as available, showing the number of full-time
				equivalent residents;
6.1.7. A
				description of any agreements moving resident "slots" from one hospital
				participating in a cooperative agreement to another pursuant to Medicare rules,
				resident programs moved from one hospital participating in a cooperative
				agreement to another, and new programs started;
6.1.8. A summary of the quality performance
				indicators of the hospitals participating in the cooperative
				agreement;
6.1.9. A comparison of
				the performance of hospitals participating in the cooperative agreement with
				the performance of similar health systems, along with a comparison to one or
				more rating agency indices for ratio of salaries and benefits to net patient
				revenue, ratio of operating EBITDA to net revenue, ratio of capital
				expenditures to depreciation, ratio of net income to net revenue (excess
				margin), days of cash on hand, days of net patient revenue outstanding, ratio
				of long-term debt to capitalization, ratio of unrestricted reserves to long
				term debt and debt service coverage ratio, along with a schedule of values for
				each component required to make the various ratio of calculations;
6.1.10. The total charity care; and
6.1.11. A current organizational
				chart.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-7 - Corrective Action Plans

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Where the
				average performance score of the parties to the cooperative agreement in any
				calendar year is below the 50th percentile for all U.S. hospitals in the
				selected quality metrics, the parties shall submit a corrective action plan to
				the authority pursuant to W. Va. Code §
									16-29B-28(g)(1)(C).
7.1.1. The authority will either accept,
				modify, or reject the corrective action plan within 30 days of receipt and
				notify the parties of the reasons for the action taken.
7.1.2. If the corrective action plan is
				modified or rejected, the parties shall submit a revised corrective action plan
				in accordance with the authority's action within 15 days of notification of the
				modification or rejection.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-8 - Rebates

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. The parties
				shall submit statistical information to the authority on an annual basis
				regarding all hospital inpatient and outpatient services.
8.1.1. The authority may order a party to
				issue rebates to health plans or insurers if either the hospital inpatient
				services or hospital outpatient services exceed the annual increase in the
				Consumer Price Index for all Urban Consumers by two percent.
8.1.2. The authority may waive the rebate if
				a party provides written justification of such excess satisfactory to the
				authority. Justification shall be submitted within 10 days of the authority's
				rebate order.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-9 - Investigations

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. The authority
				may take all actions necessary to adequately investigate whether parties comply
				with their cooperative agreements. Should the authority find that there is
				probable cause to believe that parties to the cooperative agreements previously
				approved by the authority have not complied with the provisions of W.Va. Code
				§
									16-29B-28(g), the
				authority shall provide written notice of such finding to the parties. The
				parties shall thereafter file a written response setting forth their position
				with respect to said violation and any corrective action plan which they desire
				to propose.
9.2. In the event the
				authority determines that the response is insufficient or that the corrective
				action plan is insufficient, it shall schedule and publish notice of a hearing
				before the authority at which the parties and affected parties may appear and
				offer evidence in accordance with the rules of the authority. A decision by the
				authority following such hearing shall be deemed a final decision subject to
				appeal under the Administrative Procedures Act.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-10 - Penalties

Current through Register Vol. XLI, No. 28, July 12, 2024
If the parties to a cooperative agreement fail to comply with
				  the provisions of W. Va. Code §
									16-29B-28(1)(F),
				  the authority may revoke approval of an agreement or take other appropriate
				  action.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-11 - Administrative Due Process and Judicial Review

Current through Register Vol. XLI, No. 28, July 12, 2024
The authority may initiate any legal or disciplinary action
				  available by law if the parties to a cooperative agreement have violated any
				  applicable public policy, state rule, or law, and seek enforcement in circuit
				  court.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-06 - Cooperative Agreement Approval and Compliance › Section 65-6-12 - Fees

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. All
				applications for a cooperative agreement shall be accompanied by a
				non-refundable fee of $75,000 to be submitted to the authority. Application
				review will not commence until the fee is paid.
12.2. Approved applicants shall also submit
				an annual supervision fee not to exceed $75,000 to the authority until such
				time as the cooperative agreement is terminated.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule implements the provisions of the Certificate of Need program
				found at W. Va. Code §
									16-2D-1 et
				seq. as administered by the West Virginia Health Care Authority.
1.2. Authority. -- W. Va. Code §§
									16-2D-3(b)(5),
				7(u) and 8(c).
1.3. Filing Date. --
				April 13, 2011.
1.4. Effective
				Date. -- April 13, 2011.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-3 - Certificate of Need Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. A new institutional health service may
				not be acquired, offered or developed within this state unless the board has
				issued a certificate of need for the new institutional health service. If a new
				institutional health service is exempt from certificate of need review by
				statute or this rule, the board shall issue an exemption before the new
				institutional health service is acquired, offered, or developed.
3.2. A person or health care facility may not
				knowingly charge or bill for any health service associated with a new
				institutional health service knowingly acquired, offered or developed without
				first obtaining a certificate of need from the board.
3.3. Any charge or bill for health services
				associated with a new institutional health service for which a certificate of
				need has not been issued by the board is void and legally
				unenforceable.
3.4. Donations of
				equipment or facilities to a health care facility which, if acquired directly,
				would be considered a new institutional health service subject to review by the
				board require the issuance of a certificate of need before services associated
				with the equipment or facilities may be offered or developed.
3.5. A transfer of equipment or facilities
				for less than fair market value is a new institutional health service if a
				transfer of the equipment or facilities at fair market value would be subject
				to review by the board.
3.6. The
				board may determine a series of expenditures, each less than the expenditure
				minimum, which, when taken together, are in excess of the expenditure minimum,
				to be a single expenditure subject to the review of the board. In making that
				determination, the board shall consider the following:
3.6.a. Whether the expenditures are for
				components of a system which is required to accomplish a single
				purpose;
3.6.b. Whether the
				expenditures are to be made over a two-year period and are directed towards the
				accomplishment of a single goal within the health care facility's long-range
				plan; or
3.6.c. Whether the
				expenditures are to be made within a two-year period within a single department
				and constitute a significant modernization of the department.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-5 - Expedited Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
Any person or health care facility may file a certificate of
				  need application for expedited review, upon forms approved by the board, for
				  those projects which would create a minimal impact upon the scope, quality or
				  cost of health services to be provided by the health care facility. The
				  projects may include, but are not limited to, the following:
5.1. Changes required of a facility or
				organization in order to comply with applicable building and fire codes and
				other laws, rules and standards designed to preserve life and safety or new
				institutional health services proposed to eliminate or alleviate emergency
				circumstances that pose a threat to public health;
5.2. Capital expenditures which do not
				involve the renovation or replacement of beds or a substantial change to bed
				capacity, or a substantial change to the health services of the
				facility;
5.3. The replacement of
				equipment;
5.4. The acquisition of
				health care facilities;
5.5. A
				substantial change to a new institutional health service for which a
				certificate of need is in effect;
5.6. Applications from ambulatory health care
				facilities, home health agencies, ambulatory surgical facilities and health
				maintenance organizations;
5.7.
				Applications for non-health related projects; and
5.8. Any other application within the
				discretion of the board when there are no letters of intent on file for
				projects that may be potentially unnecessarily duplicative.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-6 - Long-Range Plans

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Every
				hospital or other entity proposing a new institutional service shall submit to
				the board a long-range plan, adopted by the governing body of the hospital or
				entity as its official long-range plan, which shall consist of the overall plan
				for the health care facility proposing the new institutional service for at
				least the next five (5) years. The long-range plan shall, at a minimum, contain
				the following:
6.1.a. A description of the
				organization and its purpose and structure;
6.1.b. A statement of the goals and
				objectives of the organization as they relate to construction, new service
				development, equipment purchases, sharing or merger arrangements and staff
				recruitment;
6.1.c. An analysis of
				the resources necessary and available to accomplish the goals and
				objectives;
6.1.d. A description of
				the assumptions and rationale which form the basis for the goals and
				objectives; and
6.1.e. The proposed
				annual capital expenditure budget for each of the next three years.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-7 - Access to Information and Facilities

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon proper notice, and when reasonable and necessary in the
				  performance of the board's responsibilities in administering the certificate of
				  need program, the board shall have access to any information, records,
				  meetings, sites and/or facilities pertinent to an application or request for
				  exemption under review by the board.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-8 - Additional Information or Amendments to Application

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. 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:
8.1.a. Extend the review cycle pursuant to
				the provisions of section 13 of this rule;
8.1.b. Enter an order closing the file ten
				(10) days from the entry of the order; or
8.1.c. Withdraw the application from
				review.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-9 - Application Withdrawal

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. An
				applicant may withdraw an application under consideration by the board at any
				time prior to the issuance of a final written decision. The withdrawal of the
				application is without prejudice.
9.2. The applicant shall file with the board
				a written notice withdrawing the application before the issuance of a final
				written decision.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-10 - Batching of Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The
				board shall batch all applications which pertain to similar types of services,
				facilities or equipment affecting the same health service area into the
				following categories and shall consider the applications in relation to each
				other:
10.1.a. Medical/surgical beds or acute
				care facilities: Beds, health services or capital expenditures in excess of the
				applicable expenditure minimum;
10.1.b. Behavioral health/ psychiatric/
				chemical dependency/group homes for mental health/mental
				retardation/developmentally disabled: Beds, facilities, health services or
				capital expenditures in excess of the applicable expenditure minimum;
10.1.c. Specialized acute care: Obstetric,
				pediatric or intensive care beds, health services or capital expenditures in
				excess of the applicable expenditure minimum;
10.1.d. Medical rehabilitation: Beds, health
				services or capital expenditures in excess of the applicable expenditure
				minimum;
10.1.e. Nursing facility
				(NF)/skilled nursing facility (SNF): Long-term care beds, health services or
				capital expenditures in excess of the applicable expenditure minimum;
10.1.f. Major medical equipment: Capital
				expenditures in excess of the applicable expenditure minimum;
10.1.g. Any proposed new institutional health
				service that does not fall in batching categories (a) through (f) of this
				subsection but which directly relates to beds, major medical equipment or
				health services associated with a capital expenditure in excess of the
				expenditure minimum; and
10.1.h.
				Other proposed new institutional health services.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-11 - Application Review Procedure

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1.
				This section applies to the review of standard and expedited
				applications.
11.2. A health care
				facility shall not offer or develop in this state any new institutional health
				service, until the health care facility submits an application for a
				certificate of need and the certificate of need is approved by the board or the
				health care facility is exempt from certificate of need.
11.3. Any person proposing a new
				institutional health service shall file with the board a letter of intent at
				least fifteen (15) days before the submission of an application. The letter of
				intent shall 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 year from the date
				of their filing.
11.4. 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, the board shall not declare an application complete if:
11.4.a. 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; or
11.4.b. 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 and the rules
				promulgated pursuant to the Code.
West Virginia Code of State Rules › Agency 65 - Health Care Authority › Title 65 - LEGISLATIVE RULE HEALTH CARE AUTHORITY › Series 65-07 - Certificate Of Need Rule › Section 65-7-12 - Review Criteria

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. A
				certificate of need may only be issued if the proposed new institutional health
				service is:
12.1.a. Found to be needed;
				and
12.1.b. Except in emergency
				circumstances that pose a threat to public health, consistent with the State
				Health Plan.