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 65-5-8 - Automatic Rate Increase Applications
Current through Register Vol. XLI, No. 13, March 29, 2024
Any hospital which is licensed for one hundred (100) beds or less and is not located in a standard metropolitan statistical area which intends to revise any of its previously approved revenue limits in an amount equal to or less than the inflation factor approved by the Authority shall do so in accordance with this rule, provided that the hospital has previously implemented revenue limits approved by the Authority pursuant to the cost based rate review system and as required by section 6 of this rule.
8.1. Application - The hospital shall file an application with the Authority at least ten (10) days prior to the beginning of its fiscal year on forms to be provided by the Authority. The hospital shall submit with its application a copy of its current license issued pursuant to W. Va. Code '16-5B-1 et seq. The hospital shall also submit with its application a copy of the budget approved by the hospital's board for the fiscal year affected by the increase. The budget must contain all usual information under generally accepted accounting principles for a budget and a full and specific statement of all assumptions relied upon in preparing the budget. In the event the hospital intends to obtain approval of any discount contract pursuant to W. Va. Code '16-29B-20, the hospital shall also file with the Authority all of the information requested on forms provided by the Authority, which shall include an explanation of the requirements set forth in W. Va. Code '16-29B-20; the hospital shall also file a summary of the basic terms of the contract; a copy of the proposed discount contract; and, any other information required by the Authority. All information contained in the proposed discount contract or related thereto shall be subject to public disclosure as a public record. The provisions of this rule for consideration of discount contracts in the rate review process shall supplement the provisions for retroactive review of discount contracts for certain border hospitals pursuant to C.S.R. '65-22-1, et seq., insofar as such provisions relate to such retroactive review of discount contracts for border hospitals previously temporarily approved under C.S.R. '65-22-1, et seq., and otherwise the provisions under C.S.R. '65-22-1, et seq., regarding temporary approval of discount contracts for certain border hospitals shall apply to the temporary approval thereof. The application shall include a certification by the chief executive officer and the chairman of the board of the hospital that the information contained therein is true and accurate.
8.2. The hospital must notify the Authority at least ten (10) days prior to instituting the rate increase.
8.3. Unless a hearing is held pursuant to section 15 of this rule, the Authority shall issue a final order approving or disapproving the increase put into effect by the hospital within thirty (30) days of receipt of the application. The hospital is not prohibited from implementing the rate increase during this thirty (30) day period. The Authority's evaluation will establish that the increases in a) gross inpatient revenue per day, b) gross inpatient revenue per discharge, c) gross inpatient acute care revenue, d) outpatient revenue per visit, and e) gross outpatient revenue are equal to or less than the approved inflation factor. The determination shall be made upon the facts presented by the hospital and the records on file with the Authority. The decision shall be treated as a final order.
8.4. Within twenty (20) days of receipt of the final order, the hospital must file with the Authority a schedule of rates, each of which shall be drafted in accordance with the revenue limits set by the final order of the Authority. The schedule of rates shall indicate the date of implementation of the rates. Thereafter, the Authority shall issue a notice acknowledging receipt of the schedule of rates.
8.5. If the Authority subsequently determines that the increase put into effect by the hospital actually exceeded the rates approved by the Authority, for whatever reason, the Authority may institute a review and investigation of the hospital's rates and budget and take such action as it deems necessary to establish a new rate schedule and also direct a refund to the hospital's patients or a temporary decrease in the hospital's rates. The decision resulting from any such review and investigation may be treated as a final order.
8.6. If the hospital experiences less inpatient or outpatient utilization for the twelve (12) months following the increase than it had anticipated when the automatic rate of inflation increase was obtained, the hospital's average rate per discharge or the outpatient revenue per visit shall not later be increased to compensate for the decline in revenue without permission of the Authority.
8.7. If the hospital actually experiences revenues for non-governmental payors in excess of the limits allowed, then the hospital is notified that it is subject to all of the penalties provided for in the Act and this rule.
8.8. The Authority will continue to monitor the hospital's compliance with the Authority's prior orders. Should such monitoring reveal that the hospital exceeded its prior approved revenue limits, then the Authority will take corrective action against the hospital as a result of that excess and will also take corrective action against the rates being charged by the hospital after any automatic rate of inflation increase.
8.9. A hospital shall not file more than one rate increase application per fiscal year unless the application is filed pursuant to section 7 of this rule.
