Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-8-4 - Determination Of Certificate Of NeedRelated Adjustments To Allowed Gross Patient Revenue4.1. Application for an adjustment.4.1.1. Criteria for submission of application. -- A hospital may submit one (1) consolidated application to the Authority for an adjustment to the amount of gross patient revenue that would otherwise be allowed for the control period if: (a) It has undertaken one or more projects (excluding projects solely related to nonpatient care activities, e.g., parking garages, physician office buildings or solely for the purpose of replacing obsolete equipment) in conformance with a Certificate of Need decision or exemption letter issued pursuant to article two-d, chapter sixteen of the Code; and(b) The gross patient revenues reported by the hospital for the base period do not fully reflect obligations or volume changes directly related to projects in (a) above that were completed subsequent to July 1, 1980.4.1.2. Contents of application. -- An application for an adjustment shall include: (a) Identification of applicant hospital;(b) Copy of governing body's approval of the application and written authorization empowering specified individual(s) to sign and act on its behalf;(c) Copies of the Certificate of Need decisions and exemption letters covering all the projects to be considered in making a determination of the adjustment to be allowed;(d) The total amount of adjustment to be considered by the Authority, including a table of the proportionate amounts attributable to each project;(e) Such information, data and analysis necessary to: (1) Demonstrate that the hospital is entitled to apply for an adjustment;(2) Explain the hospital's basis for the amount of adjustment requested; and(f) Evidence of the hospital's publication of a legal advertisement in a newspaper having general circulation in the county of the hospital indicating the hospital's intent to apply to the Authority for an adjustment to the amount of allowed gross patient revenue and specifying the times, place and manner members of the public may read the application and make copies at a rate not to exceed twenty-five cents ($.25) a page.4.2. Review process. 4.2.1. Designation of staff examiner. -- Within ten (10) days of receipt of an application for an adjustment to the allowed gross patient revenue, the Authority shall designate an individual to be staff examiner for the application. The examiner designated may be an employee of the Authority, of another division of the Health Department or of another agency of state government.4.2.2. Notification of review. -- Within ten (10) days of the receipt of all parts of an application, the Authority shall notify the applicant by certified mail of the commencement of the review of the application. Public notice shall also be given and include a legal advertisement in the Charleston Daily Mail and Gazette newspapers, a local or daily newspaper in the county of the applicant's hospital and mail notice to interested persons. Said notice shall include: (a) Name of applicant's hospital;(b) Amount of adjustment requested and brief description of basis for adjustment;(c) Availability of the application for review and copying;(d) Name and address of the staff examiner for receiving written comments;(e) Date at least thirty (30) days subsequent to publication of the notice by when any written comments on the application shall be submitted to the staff examiner; and(f) Anticipated date, not less than sixty (60) days following publication of the notice, by when the staff examiner shall issue a report of proposed findings of fact and conclusions of law.4.2.3. Issuance of report by the staff examiner. -- By the date specified in the notice, the staff examiner shall submit to the Authority a report containing proposed findings of fact and conclusions of law on the application, including analyses and evaluation of evidence in support of those findings. Prior to the issuance of the report, the staff examiner may request additional information and explanations from the hospital and may extend the time by when the report is to be issued in order to allow the hospital time to supply the requested information or explanations.4.2.4. Hearing on application and staff examiner's report. -- The Authority, upon receiving the staff examiner's report, shall send to the hospital a copy of the report and notice of an opportunity for any person to request within thirty (30) days a hearing on the hospital's application and the staff examiner's report. Interested persons who were mailed notice of review shall be mailed a notice of the staff examiner's report and the opportunity to request a hearing within thirty (30) days. If a hearing is not requested, the Authority shall issue its decision in accordance with Section 4.3 of these rules infra as if a hearing were held.
If a hearing is requested, notice of the hearing shall be published in the same newspapers in which the notice of review was published. The hearing notice shall include:
(a) Name of applicant hospital;(b) Staff examiners proposed finding on the amount of adjustment to be allowed;(c) Date of hearing which shall be not less than ten (10) days following notice;(d) Time and location of hearing. Parties to the hearing shall include the applicant, the staff examiner and any affected party.
Parties may call witnesses to introduce additional evidence and testify on the evidence previously submitted, and they may cross-examine witnesses: Provided, however, That the Authority may, if the new evidence is significant, remand the matter to a staff examiner for a new review.
4.3. Issuance of Authority's decision on the application. -- Hearings and decisions shall be in accordance with section twelve, article twenty-nine-b, chapter sixteen of the Code. Until the Authority adopts procedural rules for hearings, the Authority shall conduct its hearings and issue its decisions in a manner prescribed in the West Virginia Procedural Rules, Board of Health, Chapter 16-1, Series 1, 1981, Rules of Procedure for Contested Case Hearings and Declaratory Rulings, except that in such procedural rules reference to the "Director," the "Department of Health," and the "Agency" shall mean the "Authority," and appeals shall be taken in accordance with Code section thirteen, article twenty-nine-b, chapter sixteen. The aforementioned Procedural Rules are incorporated herein by reference. Following the conclusion of the public hearing, the Authority shall issue to the parties its decision on the application determining what, if any, amount shall be permitted as an adjustment to the amount of gross patient revenue allowable during the control period. The Authority's decision shall include at least the following findings on:
(a) Whether or not the hospital has incurred obligations or increased its volume subsequent to February 1, 1982 directly as a consequence of projects undertaken in conformance with Certificate of Need decisions and exemptions; and(b) Whether or not such obligations and volume changes represent probable cause for the hospital's gross patient revenue during the control period to exceed the amount allowed for that period; and(c) The amount of adjustment determined to be necessary.