W. Va. Code R. § 65-5-7

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 65-5-7 - Temporary/Emergency Rate Applications

7.1. A hospital is eligible to obtain a temporary change in its rates if it is in the public interest and it is necessary:

a) to prevent insolvency,

b)to maintain accreditation,

c)for emergency repairs, or

d)to relieve undue financial hardship.

To qualify for a temporary change in its rates, a hospital shall submit an application to the Authority which addresses the above described criteria, describes in detail the facts which support the temporary rate change, the amount of increase in rates required to alleviate its situation, and shall summarize the overall effect of the rate increase. The claim shall be verified by the chairman of the hospital's governing body and or by the chief executive officer of the hospital.

7.2. Immediate effectiveness of application.

Upon receipt by the Authority 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 Authority may inform the hospital that the temporary rate change is to be modified to a stated amount or is denied. The hospital is required to keep a detailed and accurate account of all amounts received by reason of the temporary rate increase and the purchasers and third-party payors from whom such amounts were received.

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 approved by the Authority without resubmitting a request. The Authority's decision 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. The order shall be issued by certified mail, return receipt requested, to the hospital. The final order shall set final revenue limits and 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 Authority. If the Authority 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 Authority.

7.3. Preferential review of application.

After receipt of the claim for a temporary rate change, the Authority 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 Authority, justify temporary rate changes prior to the commencement of full review of the proposed rate change.

7.4. 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 Authority in accordance with the requirements contained in section 6 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. The hospital shall submit the information normally contained in a standard application within thirty (30) days of the request for a temporary rate increase.

7.5. Following its review of the requested increase, the Authority may allow the temporary rate increase to become permanent, deny any increase, allow a lesser increase, or 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 to the purchasers and/or third-party payors or a temporary rate decrease so as to compensate the hospital's patients and community for the disallowed increase while it was in place.

W. Va. Code R. § 65-5-7