Current through Register Vol. XLI, No. 50, December 13, 2024
5.1. In order for a border hospital to obtain temporary approval of a discount contract in the manner set forth in section four of this rule, the border hospital shall file a verified notice with the Authority, which shall be filed at least five (5) days in advance of the date upon which the proposed discount contract is to be considered temporarily approved and shall: 5.1.1. Identify the border hospital.5.1.2. State affirmatively that the border hospital is located within ten (10) miles of the border of the State of West Virginia.5.1.3. State affirmatively that the border hospital is located within ten (10) miles of an out-of-state hospital which has a similar number of beds and array of services as the border hospital.5.1.4. State affirmatively that the border hospital would be at risk to lose a significant portion of patients to out-of-state hospitals if the discount contract is not temporarily approved and if the discount contract is not confidentially maintained by the Authority upon its filing and continuing thereafter until the retroactive review of the temporary approval.5.1.5. Identify the out-of-state hospital or hospitals.5.1.6. State the number of licensed beds of the border hospital.5.1.7. State the number of licensed or registered beds of the out-of-state hospital or hospitals as identified by the appropriate state department of health.5.1.8. List the array of services offered by the border hospital.5.1.9. List the array of services offered by the out-of-state hospital or hospitals according to the American Hospital Association's most recent hospital guide.5.1.10. Identify the entity with which the border hospital has contracted.5.1.11. State the total gross and net patient revenue of the border hospital each year for the past three years.5.1.12. Project the gross and net patient revenue which the border hospital shall generate each year during the term of the discount contract.5.1.13. State affirmatively that the discount shall not decrease the charges for the services below the actual cost to the hospital.5.1.14. State affirmatively that the cost of the discount shall not be shifted to any other purchaser or third-party payor.5.1.15. State affirmatively that the discount shall not result in a decrease in the border hospital's proportion of medicare, medicaid, or uncompensated care patients.5.1.16. State affirmatively that the discount is based on criteria which constitute a quantifiable economic benefit of the border hospital.5.1.17. Include a copy of the discount contract, which shall be confidential for the purpose only of obtaining temporary approval of the contract in accordance with subsection 6.3 of this rule.5.1.18. Present such other and further information or documents as may be requested by the Authority.