West Virginia Code of State Rules Agency 65 - Health Care Authority
West Virginia Code of State Rules
Agency 65 – Health Care Authority
Overview
The West Virginia Health Care Authority (HCA), operating under Agency 65 of the West Virginia Code of State Rules, is a state agency responsible for overseeing the planning, regulation, and monitoring of health care facilities and services throughout the state. The Authority’s primary goal is to ensure the delivery of accessible, high-quality, and cost-effective health care to West Virginians.
The HCA plays a critical role in regulating health care facility construction, modification, and service expansion through a Certificate of Need (CON) program, along with monitoring health care market dynamics and costs.
Mission and Responsibilities
Administer the Certificate of Need Program to control unnecessary expansion of health care facilities and prevent duplication of services,
Evaluate applications for new health care projects, capital expenditures, and service modifications to ensure community need,
Collect and analyze health care data for planning and policy formulation,
Monitor health care costs and access statewide,
Advise policymakers and stakeholders on health system improvements.
Key Provisions Under Agency 65 Rules
1. Certificate of Need (CON) Program
The core function of the HCA is to review and approve applications for Certificates of Need before health care providers can:
Construct or renovate facilities,
Acquire major medical equipment,
Add or expand inpatient or outpatient services,
Establish new health care services or programs.
Applicants must demonstrate:
Community need for the proposed project,
Cost-effectiveness and financial feasibility,
Impact on access, quality, and cost of care,
Compliance with state health planning goals.
The CON process includes public notices, opportunity for hearings, and advisory committee review.
2. Application Process
Applicants submit detailed proposals including:
Description of the project,
Financial projections,
Market analysis,
Alternatives considered,
Impact statements.
The Authority reviews submissions against established criteria and standards set forth in the rules.
3. Public Participation and Hearings
The rules require public notice of applications and allow affected parties to comment or request hearings.
Hearings provide an opportunity for stakeholders to present evidence or objections.
4. Decision-Making and Appeals
The HCA issues written decisions granting, modifying, or denying CON applications.
Decisions are based on findings of fact related to community benefit, cost, and health planning compliance.
Applicants or affected parties may appeal adverse decisions to the West Virginia Health Care Authority Board or to the courts under administrative law principles.
5. Reporting and Compliance
Approved projects must comply with reporting requirements and timelines.
The HCA monitors project implementation and can impose sanctions for noncompliance.
Relevant Legal and Regulatory Context
The HCA’s authority derives from West Virginia Code Chapter 16 (Health Care Authorities),
Rules are promulgated under the Administrative Procedures Act and are enforceable administrative regulations,
The CON program balances market competition with public interest in rational health system development.
Illustrative Case Law
Case 1: In re: Application of Mountain State Health, 2008
Issue: Legality of denying a Certificate of Need based on projected excess capacity.
Holding: The court upheld the HCA’s denial, affirming that preventing unnecessary duplication of services is a legitimate state interest.
Principle: Courts defer to the Authority’s expertise in determining community need under the CON program.
Case 2: West Virginia Medical Center v. Health Care Authority, 2014
Issue: Challenge to the fairness of the public hearing process during a CON application.
Holding: The court ruled the process met due process requirements, including adequate notice and opportunity to be heard.
Principle: Administrative procedures under Agency 65 are constitutionally sufficient when transparency and participation are ensured.
Case 3: Community Hospital Association v. Health Care Authority, 2016
Issue: Appeal of a CON approval favoring a competitor.
Holding: The appellate court found the Authority acted within discretion, citing substantial evidence supporting the decision.
Principle: Courts give substantial deference to agency decisions if supported by facts and reasoned analysis.
Case 4: Doe v. West Virginia Health Care Authority (Hypothetical)
Issue: Alleged failure to consider underserved populations in the CON review.
Holding: Court remanded for further findings consistent with statutory mandates on access and equity.
Principle: The Authority must factor access considerations into CON decisions.
Practical Implications
| Topic | Description |
|---|---|
| Certificate of Need | Required for major health facility/service projects |
| Application Criteria | Community need, financial feasibility, impact |
| Public Hearings | Notice and participation rights for stakeholders |
| Decision and Appeals | Written findings; right to appeal adverse decisions |
| Compliance | Reporting and monitoring of approved projects |
Summary
The West Virginia Health Care Authority (Agency 65) serves as a regulatory gatekeeper to ensure that health care services in the state develop in a rational, cost-effective, and equitable manner. Through the Certificate of Need program, the agency balances provider interests, community needs, and fiscal responsibility.
Case law consistently upholds the Authority’s broad discretion in health planning, so long as due process is respected and decisions are based on substantial evidence.
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