West Virginia Code of State Rules Agency 65 - Health Care Authority
West Virginia Code of State Rules – Agency 65: Health Care Authority
Overview:
Agency 65 of the West Virginia Code of State Rules (CSR) contains rules adopted by the West Virginia Health Care Authority (HCA), the state agency responsible for health care planning, regulation, and oversight. The HCA administers programs related to certificate of need (CON) review, health care data collection, cost containment, and quality improvement for health care facilities and services across West Virginia.
Primary Functions of the Health Care Authority:
Certificate of Need (CON) Program
Reviews and approves proposals for the construction, expansion, or modification of health care facilities.
Ensures new services or capital expenditures are necessary and cost-effective.
Regulates the establishment or modification of hospitals, nursing homes, ambulatory surgical centers, and certain outpatient services.
Health Data and Quality Reporting
Collects and analyzes health care data for quality improvement and public reporting.
Oversees programs related to hospital performance, patient safety, and transparency.
Cost Containment and Planning
Develops policies and initiatives to control health care costs.
Coordinates statewide health care planning efforts.
Key Sections in Agency 65 Rules:
CSR §65-1 – General Provisions
Definitions, scope of authority, and administrative procedures.
Public participation and hearing rules.
CSR §65-2 – Certificate of Need Program
Application requirements and submission process.
Criteria for review including need, cost, access, and impact on existing providers.
Public notice and comment period.
Approval, denial, and appeal procedures.
CSR §65-3 – Health Data Reporting
Data submission requirements from health care providers.
Confidentiality and data use policies.
CSR §65-4 – Cost Containment Initiatives
Policies supporting efficient use of resources.
Programs aimed at reducing unnecessary duplication of services.
Legal Authority:
West Virginia Code Chapter 16-2D – Health Care Authority and CON statutes.
Rules implemented under the authority granted by the state legislature to regulate health care facilities and services.
Who is Regulated?
Hospitals and health care systems
Nursing homes and long-term care facilities
Ambulatory surgical centers
Other health care providers subject to CON review
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