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W. Va. Code § 16-29B-21 - Procedure for obtaining initial rate schedule; adjustments and revisions of rate schedules

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Any hospital that seeks to amend or change its schedule of rates must:

  • Make a written request (on the Board’s form) to change the rate schedule to the Board of Directors of the West Virginia Health Care Authority for review.  The Board may hold a public hearing on the proposed changes within 45 days of receiving the request.  The review must be completed within 180 days from the filing date. 
  • File a written report with the request that it has thoroughly investigated:  the economic and social impact of the proposed change, advancements in cost containment and alternatives to rate increases or service decreases, implementation of cost control systems, alternate delivery systems, and efforts to encourage third-party payers to control costs;
  • Have the right to appeal a denial of a rate increase if the Board has granted a partial increase in its rate schedule.

The Board must allow a temporary change in a hospital’s rates upon filing the request and before the request is reviewed when a hospital verifies that the change is in the public’s interest and is necessary to prevent insolvency.  After receiving the verified filing, the Board must review the claim.  Hospitals may be required to keep detailed accounts before a final order is filed if a temporary rate increased is allowed.  If the Board finds the rate increase to be excessive or unreasonable once the final order is filed, the hospital may be required to refund this portion to third-party payers.   If the Board determines that a hospital has overcharged purchasers or charged purchasers at rates not approved by the board or charged rates which were subsequently held to be excessive or unreasonable, the Board may prescribe rebates to purchasers and third-party payers.  The Board may open a proceeding against any hospital at any time with regard to compliance with rates approved and the efficiency and effectiveness of the care being rendered. 


Current as of June 2015