Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-03-6 - Temporary changes in a hospital's ratesThe legislative rules for the freeze on hospital rates and granting of temporary rate increases, West Virginia Code, article twenty-nine-b, chapter sixteen, Series II (1983), were drafted to implement Section 4 of the Act and to implement former Section 21(e) of the Act insofar as it pertained to Section 4 of the Act. Those rules do not have applicability to changes or amendments to a hospital's rate schedule.
6.1. Application for temporary rate change - In the event a hospital desires to obtain a temporary change in its schedule of rates, the hospital shall submit an application to the Authority which addresses the criteria set forth in Section 21(b) of the Act. The application must describe in detail the facts in support of the temporary rate change, the amount of increases in rates required to alleviate its situation, and shall summarize the overall effect of the rate increase. The claim shall be verified (that is, sworn to under oath) by either the chairman of the hospital's governing body or by the chief executive officer of the hospital.6.2. Immediate effectiveness of application - Upon receipt by the board of the application for a temporary rate change, the rate change shall be effective, at the hospital's discretion, immediately and until such time as the board may inform the hospital that the temporary rate change is to be modified to a stated amount or is not approved. If the rate increase is modified so that the hospital is granted only a partial increase in its rate schedule, the hospital may charge at the rate assigned by the board without resubmitting a request. The board's 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. The order shall be issued by certified mail, return receipt requested, to the hospital. The final order shall set final revenue limits, the hospital's budget, and schedule or rates. The final order shall specify the effective date of any proposed changes. 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 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.
6.3. Preferential review of application - After receipt of the claim for a temporary rate change, the board shall extend preference to hospitals demonstrating immediate risk of insolvency, or demonstrating substantial financial hardship, to maintain accreditation or for emergency repairs which in the discretion of the board justify temporary rate changes prior to the commencement of full review of the proposed rate change.6.4. Full review of application - All claims for a temporary change in a hospital's schedule of rates shall be subject to full review by the board in accordance with the principles stated in section 4 et seq. of this rule; except that, the hospital shall cause the required legal advertisement to be published within seven (7) days of filing of the application for a temporary rate change and the hospital need not submit the information normally contained in a Section 4.1 application and proposed budget, unless such information is subsequently requested by the board.6.5. Following its review of the requested increase, the Authority may allow the temporary rate increase to become permanent, to deny any increase at all, to allow a lesser increase, or to allow a greater increase. In the event the Authority desires to deny or reduce the increase, the Authority may choose to either order a refund or a temporary rate decrease so as to compensate the hospital's patients and community for the disallowed increase while it was in place.6.6. Hearings - In the event that either the Authority, a hospital, or an interested party requests a hearing on the increase, the hearing shall be conducted pursuant to section 4.3 of this rules.