Current through Register Vol. XLI, No. 45, November 8, 2024
Section 65-22-6 - Effective Date of Temporary Approval; Retroactive Review6.1. Upon obtaining temporary approval of any proposed discount contract, the contract is further subject to retroactive review by the Authority in accordance with the criteria set forth in W. Va. Code '16-29B-20 and the rate review procedures set forth in W. Va. Code '16-29B-21.6.2. The effective date of any temporary approval is the date which is five (5) days from the date of filing of a verified notice meeting the requirements of section five of this rule or the date the Authority determines the verified notice is complete, whichever first occurs.6.3. Upon receipt of a verified notice meeting the requirements of section five of this rule, the Authority shall maintain the information contained in and related to the proposed discount contract in a confidential manner to be used only by the Authority, its staff and its agents and independent contractors for regulatory purposes. The confidentiality shall be maintained only until the commencement of the retroactive review of the discount contract in accordance with subsection 6.5 of this rule. The review for all pertinent purposes shall commence upon the filing by the border hospital of its next succeeding rate application except upon the issuance by the Authority of a protective order in accordance with section seven of this rule.6.4. Following receipt of a verified notice complying with the requirements of section five of this rule, the Authority shall for the purpose of retroactive review under this rule determine within fifteen (15) days thereafter whether or not the verified notice is complete. If the verified notice is not determined complete, the Authority may request additional information from the border hospital. Upon receipt of the additional information from the border hospital, the Authority again has fifteen (15) days within which to determine whether or not the verified notice is complete.6.5. Upon determining that the verified notice is complete in accordance with the requirements of section five of this rule, the Authority shall publish a notice of the determination of completeness and/or temporary approval of the discount contract, as may be appropriate, in the Saturday Charleston newspapers and the State Register and shall retroactively review the proposed discount contract with the hospital's next succeeding rate application in order to determine whether the discount contract meets all of the requirements for final approval set forth in W. Va. Code '16-29B-20.6.6. In the event that the Authority determines that the discount contract does not meet all of the requirements for temporary approval set forth in section four of this rule subsequent to a temporary approval of the contract, the Authority may issue an order denying and revoking the temporary approval of the discount contract at any time after such temporary approval. The order is effective as of a date established by the Authority in the order. The effective date shall not be less than ten (10) days from the date of the order and which effective date may exceed ten (10) days from the date of said order in the discretion of the Authority upon good cause shown for the extension.6.7. In the event that the Authority determines during retroactive review in accordance with this section that the discount contract meets the standards for final approval of discount contracts set forth in W. Va. Code '16-29B-20, the Authority shall issue a final order approving the discount contract in accordance with the procedures for rate review set forth in W. Va. Code '16-29B-21. The final order is effective as of the date of publication of the notice of determination of completeness.6.8. In the event that the Authority determines that the discount contract does not meet the standards for final approval of discount contracts set forth in W. Va. Code '16-29B-20, the Authority shall issue a final order denying approval of the discount contract and rescinding the previous temporary approval in accordance with the procedures for rate review set forth in W. Va. Code '16-29B-21. The final order is effective as of the date established by the Authority in the order. The effective date of a final order denying approval of a discount contract which was previously temporarily approved shall not be less than ten (10) days from the date of the order, but may be extended by the Authority for a period not in excess of thirty (30) days from the date of the order upon good cause shown by the border hospital for the extension.