West Virginia Health Care Authority

Standard Rate Application

Hospitals may file one of two types of Standard Application – retroactive or non-retroactive. Retroactive (rates will be effective on the first day of the hospital’s fiscal year) applications must be filed 75 days prior to the beginning of the fiscal year and non-retroactive applications must be filed 45 days prior to the beginning of the fiscal year.  When submitting a standard application, each of the following must be completed:

 

Checklist
CBM 1 IP Discharges Instructions
CBM 1A IP Days Instructions
CBM 1B OP Visits Instructions
CBM 1C Beds and Occupancy Instructions
CBM 2 Gross IP Revenue Instructions
CBM 2A Gross OP Revenue Instructions
CBM 3 Wage and Salary (Total, Acute) Instructions
CBM 4 Operating Expenses (Total,Acute,DPU) Instructions
CBM 5 Revenue and Expenses (Total,Acute,DPU) Instructions
CBM 6 Balance Sheet
CBM 9 Monitor and Variance Instructions
CBM RO Related Organizations Instructions
CBM DC Discount Contracts (prj and budget) Instructions
CBM DCL Discount Contract List (prj and budget)
Site Map
To view Nondiscrimination Policies and Plans, please click here.