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 65-5-9 - Expedited Review

9.1. The hospital shall file an application with the Authority at least forty-five (45) 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. The Authority shall approve or deny the proposed discount contract within the one hundred eighty (180) day time period for review of rate applications set forth in subsection 6.5 of this rule. 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.

9.2. Eligibility standards - Upon receipt of the application, license and budget, the Authority shall determine:

9.3. Review by the Authority - Unless a hearing is held pursuant to section 15 of this rule, the Authority shall issue an order approving or disapproving the increase requested by the hospital within forty-five (45) days of receipt of the hospital's complete application, license and budget. This forty-five (45) day period shall not begin until the Authority receives from the hospital all the information required pursuant to this rule for a complete application including the license and budget. Within twenty (20) days of receipt by the hospital of this order, the hospital shall file with the Authority a schedule of rates, which shall be drafted in accordance with the revenue limits set by 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.

9.4. Notice to the community - Contemporaneously with the filing of the application, license and budget pursuant to section 9.1 of this rule, the hospital shall also cause to be published in a newspaper of general circulation in the county in which the hospital is located a legal advertisement setting forth the fact that the hospital is applying to the board for a change or amendment to its schedule of rates. The legal advertisement must state the requested amount of the rate increase based upon the hospital's current actual and current approved revenue limits, summarize the effect of the requested relief and further state that any person desiring to inspect the application and budget may do so at the hospital during the hospital's regular business hours and also at the offices of the board. Also, the legal advertisement shall advise the public that any person or entity who claims to be an interested party in the proceedings for the changing or amending of the schedule of rates must file with the Authority a written notice setting forth the interested party's name, address and the facts relied upon to establish his or her interest. The legal advertisement must inform the public that interested parties must file this notice within ten (10) days of the hospital's filing of its application with the Authority or else the Authority will, except for good cause shown, deny the interested party's notice. The Authority will then send notices of all proceedings and copies of all orders to those parties deemed to be affected parties in the matter. Proof of publication of the legal advertisement by the hospital must be submitted to the Authority within ten (10) days of the filing of its application, license and budget.

9.5. If the Authority determines after a final order is issued that the increase requested by the hospital actually exceeded the inflation factor 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 if necessary. The decision resulting from any such review and investigation may be treated as a final order and an appeal or reconsideration may be requested by the hospital or an affected party pursuant to sections 16 and 17 of this rule.

9.6. If the hospital experiences less inpatient or outpatient utilization for the twelve (12) months following the increase than it had anticipated when the expedited 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.

9.7. 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.