Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-03-4 - Permanent changes in the schedule of ratesExcept as provided for by section 5 of this rule, any hospital which wishes to change or amend any portion of its previously approved schedule of rates shall file an application and proposed budget as described below with the Authority. The hospital may prior to the filing of any rate increase application request a pre-application conference with the Authority's staff. The purpose of the conference will be to discuss the information needed to justify the requested increase,
4.1. Application and proposed budget - The application shall contain information requested on forms provided by the Authority as attached hereto. In addition, the hospital must provide, In a written report, the information described in West Virginia Code, subdivision (2), subsection (a), section twenty-one, article twenty-nine-b, chapter sixteen. The proposed budget should be identical in content to the budget approved by the hospital's board. The budget must contain not only all usual information under generally accepted accounting principles for a budget, but must also contain a full and specific statement of all assumptions relied upon in preparing the budget. The hospital may also submit such additional information as it wishes. All applications for adjustments in gross patient revenue due to a new service should be supported by a certificate of need decision, if applicable. The request must also include projected utilization, a rate schedule and an operating budget which details revenues and direct expenses for the new service.4.2. Public hearing - Upon receipt of the application and proposed budget, the board, if it considers necessary, may hold a public hearing on any proposed change or amendment. Such hearing shall be held no later than forty-five (45) days after receipt of the application and proposed budget. The hospital or an interested party may request a hearing which request may, in the discretion of the board, be granted.4.3. Hearings - The hearing shall be conducted pursuant to the provisions of West Virginia Code, section twelve, article twenty-nine-b, chapter sixteen, and West Virginia Code, section one, article five, chapter twenty-nine-a et seq. In addition, the Rules of Procedure for Contested Case Hearings and Declaratory Rulings, article one, chapter sixteen. Series I (1983), heretofore promulgated by the West Virginia Board of Health on December 30, 1982, are incorporated herein by reference and shall supplement the aforesaid Code provisions. The board or the hearing examiner may schedule and require attendance at a prehearing conference to be conducted by an officer appointed for that purpose by the board. The purposes of the prehearing conference shall be similar to the purposes of Rule 16, West Virginia Rules of Civil Procedure.4.4. Review by the board - Upon receipt of the hospital's application and proposed budget, the Authority's staff shall submit to the board a proposed gross revenue limit and gross patient revenue limit for that hospital. The Authority's staff may also request a conference with the hospital's officials and any interested persons. Thereafter, the board shall issue an interim order setting the hospital's revenue limits. The interim order shall be sent by certified mail, return receipt requested, to the hospital. Within forty-five (45) days of receiving the interim order, the hospital shall file with the board a revised proposed budget and a proposed schedule of rates, each of which shall be drafted in accordance with the revenue limits set by the board. Thereafter, the board shall issue a final order setting final revenue limits, the hospital's budget and schedule of rates. The final order shall specify the effective date of any proposed changes. The final order shall be sent by certified mail, return receipt requested, to the hospital. The hospital's community shall be notified of the final order through an announcement in the local media. Such notice shall not issue until twenty-four (24) hours after the final order is mailed to the hospital. The final order on any proposed change or amendment shall not be issued more than one hundred eighty (180) days from the date of filing of the application and proposed budget with the board. If the board fails to complete its review of the proposed change within the time period specified for the review, the proposed change shall be deemed to have been approved by the board.
4.5. Appeals from board's final order - Should the hospital or an interested party wish to contest the board's final order, the hospital or interested party shall file its appeal pursuant to the provisions of West Virginia Code, section thirteen, article twenty-nine-b, chapter sixteen.4.6. Rates during hearings and appeals - In the event the board 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 accordingly without in any way adversely affecting or waiving its right to contest or appeal that portion of the decision and final order of the board which denied the remainder of the requested rate increase. Similarly, if an interested party contests or appeals the decision and final order of the board, the hospital may charge its purchasers in accordance with the board's decision and final order until the final order is subsequently modified.4.7. Notice to the community - Contemporaneously with the filing of the application and proposed budget pursuant to section 4 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 shall summarize the effect of the requested relief and shall further state that any person desiring to inspect the application and proposed 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 parties' names, 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 thirty (30) 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 interested 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 and proposed budget.4.8. Reconsideration - In the event that a hospital or interested party wishes the board to reconsider a prior order, it shall file its request in writing and shall detail the grounds for the reconsideration. Such a request must be filed within twenty (20) days of the receipt by the hospital of the disputed order. A request for reconsideration shall toll the running of the period in which an appeal must be taken. The board shall respond to the request for reconsideration in writing and shall state its reasons for granting or denying the request.