W. Va. Code R. § 65-20-4

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 65-20-4 - Application

4.1. An application for a certificate of need shall be on forms approved by the board. The original and three (3) copies of the application must be submitted to the board. The application must be verified under oath by the Chief Executive Officer.

4.2. Application required for Certificate of Need. Information required for the application includes the following:

4.2.1. The identification of the applicant;

4.2.2. An authorization to pursue the project;

4.2.3. A description of the project;

4.2.4. A timetable for implementation of the project;

4.2.5. An analysis of the need for the project;

4.2.6. The policies for patient admission and provision of fully or partially uncompensated care;

4.2.7. An analysis of alternatives to the project;

4.2.8. An analysis of the project's relationship to the existing long term skilled care services in the area;

4.2.9. An analysis of the relationship of the project to the hospital's long-range plan;

4.2.10. An analysis of competitive factors;

4.2.11. The relationship of the project to licensure, certification, accreditation and safety standards;

4.2.12. The availability of resources and manpower;

4.2.13. A preliminary financial feasibility study -- The hospital must demonstrate that the proposed project is financially feasible and at a minimum provide the following:

4.2.13.a. Statements of (a) revenues and expenses, (b) balance sheet, (c) statement of changes in fund balances, and (d) statement of cash flow for the last two (2) years. Audited financial statements shall be submitted, if available;

4.2.13.b. A preliminary financial feasibility study and cash flow statements for the proposed medicare skilled nursing care unit for a three (3) year period including, at a minimum, pro forma financial statements for the current fiscal year and three (3) future years along with all assumptions upon which the projections were based.

4.2.13.c. An impact analysis or study that demonstrates the effect of the proposed project on the hospital's overall financial condition.

W. Va. Code R. § 65-20-4