Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-14-4 - Expedited ReviewAny hospital which is licensed for more than one hundred (100) beds or that is located in a Standard Metropolitan Statistical Area which wishes to change or amend any portion of its previously approved schedule of rates in an amount equal to or less than the rate of inflation as published by Data Resources/McGraw Hill shall do so in accordance with this rule.
4.1.Application, license and budget - The hospital shall file an application with the Authority at least forty-five (45) days prior to the beginning of its fiscal year on a form to be provided by the Authority. The application submitted by the hospital shall include the following: the hospital's inpatient and outpatient utilization for the previous fiscal year, the current fiscal year and the projected inpatient and outpatient utilization for the fiscal year affected by the increase; the amount of gross inpatient and outpatient revenue received by the hospital during the previous fiscal year, the current fiscal year and the projected amount of gross inpatient and outpatient revenue for the year affected by the increase; the amount of contractual allowances, uncollectable accounts, charity care, operating expenses, other operating revenue, non-operating revenue interest, non-operating revenue gifts, and non-operating revenue other for the previous fiscal year, the current fiscal year and the projected amount for the fiscal year affected by the increase. The hospital shall submit with its application a copy of its current license issued by the state director of health pursuant to West Virginia Code 16-5B-1 et seq. The hospital shall also submit with its application a copy of "the budget approved by the hospital's board for the fiscal year affected by the. increase. The budget must contain all usual information under generally accepted accounting principles for a budget and a full and specific statement of ail assumptions relied upon in preparing the budget. The application shall include a certification by the chief executive officer and the chairman of the board of the hospital that the information contained therein is true and accurate.4.2.Eligibility standards - Upon receipt of the application, license and budget, the Authority shall determine: (1) if a minimum of 365 days have elapsed since the hospital has placed into effect its last rate increase. Temporary changes in a hospital's rates made pursuant to W. Va. Code 16-29B-21(b) are excluded from this requirement; and, (2) if the hospital in its current fiscal year has provided charity care equal to or greater than the most recent state average as published by the Authority. Charity care shall be determined in accordance with the guidelines contained in the Hospital Cost Containment Methodology - Phase I, Sections 3.4.9.1, 3.4.9.1a, 3.4.9.1b, 3.4.9.1c and 3.4.9.1d (65 C.S.R. 5) and shall not include bad debt. The Authority shall also review any or . all of the following revenue limits to determine if the hospital has experienced an excess in these categories: (2) gross patient revenue, (3) gross inpatient revenue, (4) charges per discharge; and, (5) gross outpatient revenue. No hospital will be determined ineligible to request an expedited rate increase pursuant to this rule if the data submitted indicates an excess in gross outpatient revenue or an excess in gross revenue or gross patient revenue if the excess is directly attributable to the excess In gross outpatient revenue. If the Authority determines the hospital has met these standards the hospital is eligible to request an expedited rate increase pursuant to this rule. If the hospital fails to meet these standards, the hospital shall not request a rate increase pursuant to this rule.
4.3.Rate of inflation - The hospital shall determine the applicable rate of inflation for the hospital industry by referring to the most recent publication of Data Resources/McGraw-Hill. The hospital may request the Authority to provide it with the current Data Resources Index (DRI) prior to filing the application required by section 4.1 of this rule. The DRI shall be applicable for sixty (60) days from the date of the letter from the Authority notifying the hospital of said figure. The rate of inflation so reported shall not be adjusted for the increasing costs of technology, nonsupervisory wages, malpractice premiums, new services, or any other reason. 4.4Hearings - Upon receipt of a complete application, license and budget, the board, in its discretion, may hold a public hearing. Such hearing shall be held no later than forty-five (45) days after receipt of the complete application, license and budget. The hospital or an interested party may request a hearing which request may, in the discretion of the board, be granted. The hearing shall be conducted pursuant to 65 C.S.R. 3, section 4.3. 4.5.Review by the board - Unless a hearing is held pursuant to section 4,4 of this rule, the board shall issue an order approving or disapproving the increase requested by the hospital within forty-five (45) days of receipt of the hospital's complete application, license and budget. This forty-five (45) day period shall not begin until the Authority receives from the hospital all the information required pursuant to this rule for a complete application including the license and budget. Within 45 days of receipt by the hospital of this order, the hospital shall file with the board a revised budget and a 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 second order setting final revenue limits, the hospital's budget and schedule of rates. The initial order shall specify the effective date of any increase and the hospital is prohibited from implementing any rate increase until the date specified in the initial order. All orders shall be sent by certified mail, return receipt requested, to the hospital. An appeal or reconsideration of an order entered pursuant to this section (4.5) may be requested by the hospital or an interested party pursuant to 65 C.S.R. 3, sections 4.5 and 4.8. 4.6Notice to the Community - Contemporaneously with the filing of the application, license and budget pursuant to section 4.1 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 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 ten (10) 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, license and budget.4.7. If the board determines after a final order is issued that the increase requested by the hospital actually exceeded the rate of inflation as published by Data Resources/McGraw-Hill, 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 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 65 C.S.R. 3, sections 4.5 and 4-8.4.8. This rule 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 expedited rate of inflation increase was obtained, the hospital's average rate per discharge shall not later be increased to compensate for the decline in gross inpatient revenue without permission of the board.4.9. 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 shall take corrective action against the hospital as a result of that excess and shall also take corrective action against the rates being charged by the hospital after any expedited rate of inflation increase.