Current through Register Vol. XLI, No. 50, December 13, 2024
Section 65-19-4 - RequirementsAny hospital which is licensed for one hundred (100) beds or less and is not located in a standard metropolitan statistical area which wants 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. The hospital must file an application, a copy of the proposed budget approved by the hospital's board, and a copy of its license with the Authority at least five (5) days prior to the beginning of the hospital's fiscal year. The application shall be on a form to be provided by the Authority. A minimum of three hundred sixty-five (365) days shall have elapsed since the hospital placed into effect its last rate increase.4.2. At least five (5) days prior to the beginning of its fiscal year and five (5) days prior to instituting the increase, the hospital must notify the Authority of its intention to implement the increase.4.3. 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.4.4. Within thirty (30) days after implementing the increase in its gross inpatient revenues per discharge for its non-governmental payors, the hospital shall file an amendment to its schedule of rates reflecting the effect of the increase.4.5.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 subsection 4.1 of this rule. The DRI shall be applicable for sixty (60) days from the date of this letter from the Authority notifying the hospital of the figure. The rate of inflation shall not be adjusted for the increasing costs of technology, nonsupervisory wages, malpractice premiums, new services, or any other reason.4.6. Within thirty (30) days of receiving the hospital's schedule of rates as required by subsection 4.4 of this rule, the Authority shall issue a decision approving or disapproving the increase put into effect by the hospital. The hospital may implement the rate increase during this thirty (30) day period. The Authority's evaluation will be limited to the rate of increase for gross inpatient revenues per discharge for non-governmental payors and will establish that the increase is equal to or less than the rate of inflation as established by the DRI. The decision shall be made upon the facts presented by the hospital and the records on file with the Authority, The decision is an appealable order.4.7. Notwithstanding the provisions of subsection 4.6 of this rule, if the board subsequently determines that the increase put into effect by the hospital actually exceeded the rate approved by the Authority, for whatever reason, the Authority may institute a review and investigation of the hospital's rates and budget and take such action as it considers 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. The decision resulting from the review and investigation is appealable.4.8. This section also applies to any hospital which seeks to increase or decrease its outpatient revenue or its nonpatient revenues from nongovernmental 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 compensate for the decline in gross inpatient revenue without permission of the Authority.4.9. "Fop hospitals which have obtained an automatic rate of inflation increase, if the hospital actually experiences gross inpatient revenues per discharge for non-governmental payors in excess of the amount it was allowed, then the hospital is subject to ail of the penalties provided for by W. Va. Code, § 16-293-1 et seq., including refunds and temporary rate decreases as provided for by W. Va. Code, § 16-29B-21(d) and (e), and also the criminal provisions of W. Va. Code, § 16-29B-27. Liability will be determined by reference to those sections and not by these rules. 4.10. While the automatic rate of inflation increase is calculated upon the actual average revenue per discharge for the hospital's past fiscal year, the Authority will continue to monitor the hospital's compliance with the Authority's prior orders. Should such monitoring reveal that the hospital exceeded its prior revenue limits, then the Authority 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.