Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-03-5 - Automatic rate of inflation increases5.1. Any hospital which wishes to increase its gross inpatient revenues per discharge for nonmedicare and nonmedicaid payors in an amount equal to or less than the rate of inflation for the hospital industry nationally shall do so in accordance with this rule.5.2. At least five (5) days prior to instituting the increase, the hospital must notify the Authority of its intention to implement the increase. The notice shall include completion of the form attached to these rules for such increases.5.3. The hospital must inform the Authority of its inpatient utilization during the fiscal year prior to the date of the notice and the anticipated inpatient utilization for the fiscal year affected by the increase. The hospital shall also inform the Authority of the amount of gross inpatient revenue it received for the fiscal year prior to the increase and the amount of gross inpatient revenue it expects to receive during the fiscal year affected by the increase.5.4. Within thirty (30) days after implementing the increase in its gross inpatient revenues per discharge for its nonmedicare and nonmedicaid payors, the hospital shall file an amendment to its schedule of rates and a revised budget both reflecting the effect of the increase.5.5. The hospital shall determine the applicable rate of inflation for the hospital industry by referring to the most recent "hospital and related services" item of the Consumer Price Index for all urban consumers as reported by the United States Bureau of Labor Statistics for the hospital's immediately completed fiscal year. The hospital may request the Authority to provide it with this figure prior to filing the notice required by section 5.2 of this rule. The rate of inflation so reported shall not be adjusted for increasing costs of technology, increases in nonsupervisory wages, malpractice premiums, new services, or any other reason.5.6. Within thirty (30) days of receiving the hospital's schedule of rates and revised budget as required by section 5.4, the Authority shall issue a decision approving or disapproving the increase put into effect by the hospital. The hospital is not prohibited from implementing the rate increase during this thirty (30) day period. The HCCRA's evaluation will be limited to the rate of increase for gross inpatient revenues per discharge for nonmedicare and nonmedicaid payors and will establish that the increase is equal to or less than the rate of inflation for the hospital industry nationally. The determination shall be made upon the facts presented by the hospital and the records on file with the Authority. The decision may be treated as a final order and an appeal or reconsideration may be requested by the hospital or an interested party pursuant to sections 4.5 and 4.8 of this rule.5.7. Notwithstanding the provisions of section 5.6 of this rule, if the board subsequently determines that the increase put into effect by the hospital actually exceeded the national rate of inflation for the hospital industry, for whatever reason, the board 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 any of such should prove 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 interested party pursuant to sections 4.5 and 4.8 of this rule.5.8. This section also applies to any hospital which seeks to increase or decrease its outpatient revenue or its nonpatient revenues from nonmedicare or nonmedicaid sources. In addition, if the hospital experiences less inpatient 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 shall not later be increased to make up for the decline in gross inpatient revenue without permission of the board.5.9. For hospitals which have obtained an automatic rate of inflation increase, if the hospital actually experiences gross inpatient revenues per discharge for nonmedicare and nonmedicaid payors in excess of the amount it was allowed, then the hospital is notified that it may be subject to all of the penalties provided for by the Act including refunds and temporary rate decreases as provided for by West Virginia Code, subsection (d) of section twenty-one, article twenty-nine-b, chapter sixteen, and also the criminal provisions of West Virginia Code, section twenty-seven, article twenty-nine-b, chapter sixteen. Such liability will be determined by reference to those sections and not by these rules. 5.10. Hearings - In the event that either the Authority, the hospital, or an interested party requests a hearing on the increase, the hearing shall be conducted pursuant to section 4.3 of this rule.5.11. While the automatic rate of inflation increase will be calculated upon the actual average revenue per discharge for the hospital's past fiscal year, the board will continue to monitor the hospital's compliance with the board's prior orders. Should such monitoring reveal that the hospital exceeded its prior revenue limits, then the board 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.