The following words and terms, when used in this chapter, shall have the following meanings:

"Adjusted patient days" means inpatient days divided by the percentage of inpatient revenues to total patient revenues.

"Annual historical filing" or "filing" means facility specific data elements and financial statements submitted to the Board of Health on an annual basis by a medical care facility located in Virginia, including utilization, revenue, deductions from revenue, expenses, assets, liabilities, and related statistics.

"Board" means the State Board of Health.

"Certified nursing facility" means any skilled nursing facility, skilled care facility, intermediate care facility, nursing or nursing care facility, or nursing home, whether freestanding or a portion of a freestanding medical care facility, that is certified as a Medicare or Medicaid provider, or both, pursuant to § 32.1-137 of the Code of Virginia.

"Consumer" means any person (i) whose occupation is other than the administration of health activities or the provision of health services, (ii) who has no fiduciary obligation to a health care institution or other health agency or to any organization, public or private, whose principal activity is an adjunct to the provision of health services, or (iii) who has no material financial interest in the rendering of health services.

"Health care institution" means (i) a general hospital, ordinary hospital, or outpatient surgical hospital, nursing home or certified nursing facility licensed or certified pursuant to Article 1 (§ 32.1-123 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, (ii) a mental or psychiatric hospital licensed pursuant to Chapter 8 (§ 37.1-179 et seq.) of Title 37.1 of the Code of Virginia or (iii) a hospital operated by the University of Virginia or Virginia Commonwealth University. In no event shall such term be construed to include continuing care retirement communities which file annual financial reports with the State Corporation Commission pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 of the Code of Virginia, any physician's office, nursing care facility of a religious body which depends upon prayer alone for healing, independent laboratory or outpatient clinic.

"Continuing care retirement community" means a retirement community which operates in accordance with the requirements of Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 of the Code of Virginia.

"Hospital" means any a facility licensed pursuant to § 32.1-123 et seq. or § 37.1-179 et seq. in which the primary function is the provision of diagnosis, of treatment, and of medical and nursing services, surgical or nonsurgical, for two or more nonrelated individuals, including hospitals known by varying nomenclature or designation such as children's hospitals, sanatoriums, sanitariums, and general, acute, rehabilitation, chronic disease, short-term, long-term, outpatient surgical, and inpatient or outpatient maternity hospitals; any facility licensed pursuant to Article 2 (§ 37.2-403 et seq.) of Chapter 4 of Title 37.2 of the Code of Virginia.; or a hospital operated by the Department of Behavioral Health and Developmental Services for the care and treatment of individuals with mental illness.

"Late charge" means a fee that is assessed a health care institution that submits any of the board's filings past the due date.

"Medical care facility" means an institution, place, building or agency, whether or not licensed or required to be licensed by the Board or the Department of Behavioral Health and Developmental Services, whether operated for profit or nonprofit and whether privately owned or privately operated or owned or operated by a local government unit, (i) by or in which health services are furnished, conducted, operated, or offered for the prevention, diagnosis, or treatment of human disease, pain, injury, deformity, or physical condition, whether medical or surgical, of two or more nonrelated persons who are injured or physically sick or have mental illness, or for the care of two or more nonrelated persons requiring or receiving medical, surgical, nursing, acute, chronic, convalescent, or long-term care services, or services for individuals with disabilities; or (ii) which is the recipient of reimbursements from third-party health insurance programs or prepaid medical service plans. The term "medical care facility" shall not include (i) any facility of the Department of Behavioral Health and Developmental Services; (ii) any nonhospital substance abuse residential treatment program operated by or contracted primarily for the use of a community services board under the Department of Behavioral Health and Developmental Services' Comprehensive Plan; (iii) an intermediate care facility for individuals with intellectual disability (ICF/MR) that has no more than 12 beds and is in an area identified as in need of residential services for individuals with intellectual disability in any plan of the Department of Behavioral Health and Developmental Services; (iv) a physician's office, except that portion of a physician's office described in subsection 9 of 12VAC5-215-15; (v) the Woodrow Wilson Rehabilitation Center of the Department of Aging and Rehabilitative Services. "Medical care facility" shall also not include that portion of a physician's office dedicated to providing nuclear cardiac imaging.

"Nonprofit organization" means a nonprofit, tax-exempt health data organization with the characteristics, expertise and capacity to execute the powers and duties set forth for such entity in Chapter 7.2 (§ 32.1-276.2 et seq.) of Title 32.1 of the Code of Virginia, and with which the State Health Commissioner has entered into a contract as required by the Code of Virginia.

"Nursing home" means any facility or any identifiable component of any facility licensed pursuant to Article 1 (§ 32.1-123 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, in which the primary function is the provision, on a continuing basis, of nursing services and health-related services for the treatment and inpatient care of two or more nonrelated individuals, including facilities known by varying nomenclature or designation such as convalescent homes, skilled nursing facilities or skilled care facilities, intermediate care facilities, extended care facilities and nursing or nursing care facilities.

"Patient day" means a unit of measure denoting lodging facilities provided and services rendered to one inpatient, between census-taking-hour on two successive days. The day of admission but not the day of discharge or death is counted a patient day. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day. For purposes of filing fees to the board, Board, newborn patient days would be added. shall be counted as the first patient day. For a medical facility, such as an ambulatory surgery surgical center, which does not provide inpatient services, each patient undergoing surgery during any one 24-hour period will be equivalent to one patient day.

For purposes of this chapter, only the following medical care facilities shall be subject to review:

1. General hospitals;

2. Sanitariums;

3. Nursing homes;

4. Intermediate care facilities, except an intermediate care facility established for individuals diagnosed with an intellectual disability that have no more than 12 beds and are in an area identified as in need of residential services for individuals with intellectual disability in any plan of the Department of Behavioral Health and Developmental Services;

5. Extended care facilities;

6. Mental hospitals;

7. Facilities for individuals with an intellectual disability;

8. Psychiatric hospitals and intermediate care facilities established primarily for the medical, psychiatric or psychological treatment and rehabilitation of individuals with substance abuse;

9. Specialized centers or clinics or that portion of a physician's office developed for the provision of outpatient or ambulatory surgery, cardiac catheterization, computed tomographic (CT) scanning, stereotactic radiosurgery, lithotripsy, magnetic resonance imaging (MRI), magnetic source imaging (MSI), positron emission tomographic (PET) scanning, radiation therapy, stereotactic radiotherapy, other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy, proton beam therapy, nuclear medicine imaging, except for the purpose of nuclear cardiac imaging, or such other specialty services as may be designated by the Board by regulation;

10. Rehabilitation hospitals; and

11. Any facility licensed as a hospital.

The board, by §§ 32.1-276.2 through 32.1-276.11 of the Code of Virginia, is required to collect, analyze and make public certain financial data and findings relating to hospitals which operate within the Commonwealth of Virginia. Sections 32.1-276.7 and 32.1-276.8 of the Code of Virginia direct the board from time to time to make such rules and regulations as may be necessary to carry out its responsibilities as prescribed in the Code of Virginia.

A. The board has promulgated these rules and regulations to set forth an orderly administrative process by which the board may govern its own affairs and require compliance with the provisions of §§ 32.1-276.2 through 32.1-276.11 of the Code of Virginia.

B. These rules and regulations are administered by the board.

C. These rules and regulations have general applicability throughout the Commonwealth. The requirements of the Virginia Administrative Process Act, codified as § 9-6.14:1 et seq. of the Code of Virginia, apply to their promulgation.

D. These rules and regulations or any subsequent amendment, modification, or deletion in connection with these rules and regulations shall become effective 30 days after the final regulation is published in The Virginia Register.

A. The nonprofit organization shall obtain the data collected by other public and private agencies or entities that is used by the Board to evaluate each medical care facility directly from the appropriate agency or entity.

B. The nonprofit organization shall obtain the data used by the Board in its evaluation of each medical care facility from the Virginia Patient Level Data System, and from other available databases.

The board reserves the right to authorize any procedure for the enforcement of these regulations that is not inconsistent with the provision set forth herein and the provisions of §§ 32.1-27 and 32.1-276.11 of the Code of Virginia.

The nonprofit organization shall assemble information concerning charges, costs, elements of costs, efficiency, productivity, resource utilization, financial viability, and community support services from the filings made pursuant to this chapter.

Each individual health care institution shall submit an annual historical filing of revenues, expenses, other income, other outlays, assets and liabilities, units of service, and related statistics as prescribed in § 9-158 (Repealed) of the Code of Virginia on forms provided by the board together with unconsolidated certified audited financial statements. If the health care institution is part of a publicly held company, the individual institution may submit unconsolidated unaudited financial statements. Investor-owned institutions organized as proprietorships, partnerships, or S-corporations that impute income tax on the annual historical filing report an imputed income tax based on the maximum tax rates for federal and state income. The combined rate for 1989 is equal to 34% for individuals and 40% for corporations. Operating losses may be carried forward no more than five years but may not be carried back to prior years. The schedule of imputed income taxes shall be reported as a note to the financial statements or as a supplemental schedule of the certified audited financial statements submitted to the board by the institution. The annual historical filing and the unconsolidated certified audited financial statement shall be received by the board no later than 120 days after the end of the respective applicable health care institution's fiscal year. The requirement for the submission of an annual historical filing and an unconsolidated certified audited financial statement may be waived if a health care institution can show that an extenuating circumstance exists. Requests for a waiver must be submitted in writing prior to the due date. Examples of an extenuating circumstance include, but are not limited to, involvement by the institution in a bankruptcy proceeding, closure of the institution, change of ownership of the institution, or the institution is a new facility that has recently opened.

Each health care institution with licensed nursing home beds or certified nursing facility beds shall exclude all revenues, expenses, other income, other outlays, assets and liabilities, units of service and related statistics directly associated with a hospital, continuing care retirement community, or with adult care residence beds in the annual report filed with the board. For those health care institutions that participate in either the Medicare or Medicaid program, the cost allocation methodology required by the Virginia Department of Medical Assistance Services and Medicare for cost reports submitted to it shall be utilized for filings submitted to the board. Any health care institution that does not participate in the Medicare or Medicaid program may develop and utilize an alternative methodology to determine the nursing home portion of its costs if it chooses not to utilize the cost allocation methodology used by the Department of Medical Assistance Services and Medicare. That methodology shall then be approved by the board and the health care institution must continue to utilize that methodology for all subsequent filings unless a subsequent change is approved by the board.

A. A medical care facility shall submit an annual historical filing and unconsolidated certified audited financial statements to the nonprofit organization, in accordance with 12VAC5-215-35.

1. If a medical care facility is part of a publicly held company, the individual institution may submit unconsolidated unaudited financial statements with the annual historical filing.

2. Investor-owned medical care facilities organized as proprietorships, partnerships, or S-corporations that impute income tax on the annual historical filing shall report an imputed income tax based on the maximum tax rates for federal and state income. Operating losses may be carried forward no more than five years but shall not be carried back to prior years.

B. A medical care facility shall submit the annual historical filing and the unconsolidated certified audited financial statements, or unconsolidated unaudited financial statements submitted by a medical care facility that is a publicly held company, no later than 120 days after the end of the medical care facility's fiscal year. The Board may waive the requirement for the submission of an annual historical filing and an unconsolidated certified audited financial statement, or an unconsolidated unaudited financial statement submitted by a medical care facility which is a publicly held company, if the medical care facility shows that an extenuating circumstance exists. A medical care facility shall submit the request for a waiver to the Board in writing before the due date.

C. Pursuant to § 32.1-276.5 of the Code of Virginia, a filing made to the nonprofit organization by the parent company of a medical care facility which is required to report the annual historical filing in accordance with this chapter shall submit the filing within 150 days after the end of the parent company's fiscal year.

D. A medical care facility with licensed nursing home beds or certified nursing facility beds shall exclude all revenues, expenses, other income, other outlays, assets and liabilities, units of service, and related statistics directly associated with a hospital, continuing care retirement community, or with adult care residence beds in the annual historical filing submitted to the Board.

1. A medical care facility that participates in the Medicare or Medicaid program shall utilize the cost allocation methodology required by the Virginia Department of Medical Assistance Services and Medicare for cost reports submitted to the Board.

2. A medical care facility that does not participate in the Medicare or Medicaid program may develop and submit an alternative cost allocation methodology to the Board for approval. A medical care facility that receives Board approval to utilize an alternative cost allocation methodology shall utilize the methodology for all future filings unless a subsequent change is approved by the Board.

E. The nonprofit organization shall make available on its website a complete list of the data elements required to be included in the annual historical filing submitted by medical care facilities that are required to report Efficiency and Productivity Information Collection System information.

F. For purposes of this section, "Efficiency and Productivity Information Collection System," or "EPICS," means a system that collects financial and operational data on each ambulatory surgical center, hospital, and nursing home that is used by consumers to compare the efficiency and productivity of each medical care facility.

A. For purposes of this section, "case mix index" shall mean a medical care facility's resource consumption, as measured by the nonprofit organization with which the Commissioner contracts to evaluate the efficiency and productivity of each medical care facility that operates in the Commonwealth, pursuant to § 32.1-276.4 of the Code of Virginia.

B. The nonprofit organization shall evaluate and rank each medical care facility by forming and using indicators, including a medical care facility's case mix index, that derive from the individual data elements from the general categories identified in § 32.1-276.6 of the Code of Virginia.

C. The nonprofit organization may use the 3M APR DRG Classification system and Virginia patient level data from each licensed hospital to calculate the hospital's case mix index.

D. The nonprofit organization may use the Nursing Facility Price Based Reimbursement methodology available from the Department of Medical Assistance Services as outlined in 12VAC30-90-44 to calculate a nursing home's case mix index.

Each health care institution shall file annually a schedule of charges to be in effect on the first day of such fiscal year, as prescribed in § 9-159 A 3 (Repealed) of the Code of Virginia. The institution's schedule of charges shall be received by the board within 10 days after the beginning of its respective applicable fiscal year.

Any subsequent amendment or modification to the annually filed schedule of charges shall be filed within 10 days of the effective date of the revised annual projection. In addition to the requirement above, a new schedule of charges must be submitted if any of the following conditions exist: (i) the creation or revision of a markup or pricing methodology, or (ii) the creation or revision of charges for new services or products. Amendments or modifications to a schedule of charges that are due only to cost adjustments resulting from the pass through of a markup or pricing methodology that had been implemented since the beginning of the fiscal year are considered minimal and need not be reported.

A. The nonprofit organization shall publish an annual report which incorporates the data collected and analysis of the data which includes an evaluation of the relative efficiency and productivity of each Virginia medical care facility required to report in accordance with 12VAC5-215-35, cost per admission comparison, cost per patient day comparison, operating profits and losses, deductions from revenue (contractuals, bad debts, charity care), and utilization.

B. The nonprofit organization shall maintain an electronic database open to the public containing information drawn from annual historical filings provided by each medical care facility required by law to report.

Each health care institution shall file annually a survey of rates charged. For hospitals, the survey shall consist of up to 30 select charges, including semi-private and private room rates. The survey shall also consist of charges of the most frequently occurring diagnoses or procedures for inpatient and outpatient treatment. The charges shall be calculated by taking an average for one month of all patient bills where the requested CPT or ICD-9 code numbers are indicated as the principal diagnosis or procedure. For hospitals this information shall be received by the board no later than April 30 of each year.

The annual charge survey for nursing homes shall include up to 30 select charges, including semi-private and private room rates. The select charges shall reflect the rates in effect as of the first day of a sample month to be chosen by the board. For nursing homes this information shall be received by the board no later than March 31 of each year.

A. A medical care facility shall submit a filing required by this chapter to the Board in an electronic format using a secure web data collection tool developed by the Board for such purpose.

B. A medical care facility that does not have the equipment to submit an electronic filing to the Board may apply to the Board for an exemption to subsection A of this section. The Board shall assess a fee charged to a medical care facility that receives an exemption from electronically submitted data that is commensurate with the cost of data entry.

Each hospital or any corporation that controls a hospital shall respond to a survey conducted by the board to determine the extent of commercial diversification by such hospitals in the Commonwealth. The survey shall be in a form and manner prescribed by the board and shall request the information specified in subdivisions a through j below for each affiliate of such hospital or corporation, if any:

a. The name and principal activity;

b. The date of the affiliation;

c. The nature of the affiliation;

d. The method by which each affiliate was acquired or created;

e. The tax status of each affiliate and, if tax-exempt, its Internal Revenue tax exemption code number;

f. The total assets;

g. The total revenues;

h. The net profit after taxes, or if not-for-profit, its excess revenues;

i. The net equity or, if not-for-profit, its fund balance; and

j. Information regarding related party transactions.

A. The Board shall determine a fee charged to each hospital and a fee charged to each nursing home that is based upon (i) the Board's proportionate costs of operation for review of a medical care facility's annual historical filing in the current fiscal year; (ii) the Board's anticipated costs for review of a medical care facility's annual historical filing in the next fiscal year; and (iii) the adjusted patient days included in a medical care facility's most recent annual historical filing submitted to the Board. The Board shall determine the fee before the beginning of a new fiscal year.

B. A hospital or nursing home shall pay the required fee directly to the nonprofit organization.

C. The Board shall not establish a fee of more than 11 cents per adjusted patient day for a medical care facility.

D. A medical care facility shall pay the fee to the nonprofit organization at the same time it submits the annual historical filing to the Board as required by 12VAC5-215-75.

The information specified in 12VAC5-215-80 shall relate to any legal controls that exist as of the hospital's fiscal year end. The response to the survey shall include the required information for all affiliates in which the hospital or any corporation which controls a hospital has a 25% or greater interest. Information regarding affiliates or organizations that do not have corporate headquarters in Virginia and that do no business in Virginia need not be provided.

A. The Board shall impose a late charge of $10 per working day on a medical care facility that submits an annual historical filing, unconsolidated audited financial statement, unconsolidated unaudited financial statement filed by a publicly held company, or fee payment made to the nonprofit organization after the due date for such submission.

B. The Board may waive a late charge imposed on a medical care facility if the medical care facility requests the waiver before the due date for the submission of the annual historical filing, unconsolidated audited financial statement, unconsolidated unaudited financial statement filed by a publicly held company, or fee payment, if the medical care facility demonstrates that an extenuating circumstance exists which has impeded its ability to submit the annual historical filing, unconsolidated audited financial statement, unconsolidated unaudited financial statement filed by a publicly held company, or fee payment by the due date.

Each hospital that reports to the board or any corporation which controls a hospital that reports to the board shall submit audited consolidated financial statements and consolidating financial schedules to the board which include its total assets, liabilities, revenues, expenses, and net worth.

A medical care facility shall be subject to a geographic peer grouping and ranking procedure, unless otherwise exempt under 12VAC5-215-115.

1. Medical care facilities of a similar type shall be grouped into geographical peer groups and ranked in relation to other medical care facilities within the peer group.

2. Each medical care facility shall be ranked on individual indicators and shall be given a quartile score of 1, 2, 3, or 4 on each indicator. Each quartile shall represent 25% of the medical care facilities within a peer group, but shall be dependent upon the quartile within which each indicator falls. A quartile score of 1 on an indicator means that an institution is ranked in the top quartile on that particular indicator.

The information required by 12VAC5-215-80, 12VAC5-215-90, and 12VAC5-215-100 shall be due 120 days after the hospital's fiscal year end.

A. The following medical care facilities shall be exempt from the ranking procedure until a resource utilization adjustor is developed and adopted by the Board:

1. Psychiatric hospitals;

2. Rehabilitation hospitals;

3. Ambulatory surgical hospitals;

4. Critical access hospitals;

5. Children's specialty hospitals;

6. Subacute care hospitals; and

7. Long-term acute care hospitals.

B. The nonprofit organization may sort a medical care facility listed in subsection A of this section into other peer groupings for the purpose of analysis.

Each health care institution that reports to the board, any corporation controlling a hospital, and each affiliate of the hospital or corporation that controls a hospital shall submit, if the health care institution, corporation, or affiliate is an organization exempt from taxes pursuant to § 501(C)(3) of the Internal Revenue Code, a copy of the most recent federal information return (Form 990) which was filed on behalf of the institution, corporation, or affiliate together with all accompanying schedules that are required to be made available to the public by the Internal Revenue Service. Information regarding not-for-profit affiliates which do no business in Virginia need not be submitted.

The information required by this section shall be due to the board 120 days after the completion of the health care institution's fiscal year end. If the information return (Form 990) has not been filed with the Internal Revenue Service, the due date will be extended to no later than the normal due date to the IRS or any extensions granted.

The Board shall release historical financial and statistical data reported by each medical care facility pursuant to § 32.1-276.4 of the Code of Virginia. All releases of historical financial and statistical data shall conform to the restrictions and provisions of § 32.1-276.9 of the Code of Virginia.

All filings required by this chapter will be made to the board.

A. A continuing care retirement community that includes nursing home beds shall report data on the utilization of the nursing home beds to the nonprofit organization.

B. A continuing care retirement community approved by the Commissioner for a certificate of public need pursuant to subsection E of § 32.1-102.3:2 of the Code of Virginia before July 1, 2013, and which seeks a three-year open admission period as permitted under § 32.1-102.3:8 of the Code of Virginia, shall submit the facility's occupancy holder rate to the nonprofit organization for the six-month period preceding the facility's application for an open admission period.

A fee based on an adjusted patient days rate shall be set by the board, based on the needs to meet annual board expenses. The fee shall be established at least annually and reviewed for its sufficiency at least annually by the board. All fees shall be paid directly to the board. The fee shall be no more than 11 cents per adjusted patient day for each health care institution. Prior to the beginning of each new fiscal year, the board shall determine a fee for hospitals and a fee for nursing homes based upon the board's proportionate costs of operation for review of hospital and nursing home filings in the current fiscal year, as well as the anticipated costs for such review in the upcoming year.

Fifty percent of the fee shall be paid to the board no later than 30 days before the beginning of the health care institution's fiscal year. The fee shall be based on the health care institution's most recently submitted annual historical adjusted patient days. If there have been no previous annual historical filings, the health care institution's fee shall be based on its projected adjusted patient days for the fiscal year. The balance of the fee shall be paid to the board at the same time the health care institution submits its annual historical filing under the provisions of 12VAC5-215-50.

A. A late charge shall be paid to the board by a health care institution that files reports or fees past the due date. The late charge may be waived if such a waiver is requested prior to the due date and the health care institution can show that an extenuating circumstance exists. Examples of extenuating circumstances include, but are not limited to, involvement by the institution in a bankruptcy proceeding, closure of the institution, change of ownership of the institution, or the institution is a new facility that has recently opened.

B. A late charge of $10 per working day shall be paid to the board by a health care institution that files its annual historical filing, unconsolidated audited financial statements or fees past the due date.

C. A late charge of $50 shall be paid to the board by the health care institution that files the charge schedule past the due date.

D. A late charge of $25 per working day shall be paid to the board by the reporting entity required to complete the survey required by 12VAC5-215-80 including the audited consolidated financial statement required by 12VAC5-215-100, or both.

E. A late charge of $25 per working day shall be paid to the board by the reporting entity required to complete the survey required by 12VAC5-215-70.

F. A late charge of $25 per working day shall be paid to the board by the reporting entity required to submit the Form 990s as provided by 12VAC5-215-120.

A. The annual historical filing data submitted by health care institutions as prescribed in 12VAC5-215-50 shall be analyzed as directed by the board.

B. The annual schedule of charges shall be analyzed as directed by the board.

Periodically, but at least annually, the board will publish the rates charged by each health care institution in Virginia for up to 30 of the most frequently used services in Virginia, including each institution's average semi-private and private room rates. The data will be summarized by geographic area in Virginia, and will be kept on file at the board office for public inspection and made available to the news media. In addition, annual charge schedules and subsequent amendments to these schedules filed under the provisions of 12VAC5-215-60 will be kept on file at the board office for public inspection.

Periodically, but at least annually, the board will publish an annual report which will include, but not be limited to the following: cost per admission comparison, cost per patient day comparison, percentage increase in cost per patient day, operating profits and losses, deductions from revenue (contractuals, bad debts, and charity care) and utilization.

The board will also periodically publish and disseminate information which will allow consumers to compare costs and services of hospitals, nursing homes and certified nursing facilities.

The board shall release historical financial and statistical data reported by health care institutions pursuant to §§ 32.1-276.2 through 32.1-276.11 of the Code of Virginia. Under no circumstances will data be released which contains "personal information" as defined in § 2.1-379(2) of the Code of Virginia.

Hospital Annual Historical Filing Form, 03-01, revised 4/30/96.

Ambulatory Surgical Hospital Annual Historical Filing Form, 03-02, revised 4/30/96.

Nursing Home Annual Historical Filing Form, 03-03, revised 4/30/96.

Income Statement Reconciliation Worksheet, 04-04, revised 4/30/96.

Psychiatric Hospital Annual Historical Filing Form, 03-05, revised 4/30/96.

Rehabilitation Hospital Annual Historical Filing Form, 03-06, revised 4/30/96.

Acute, Children's, Critical Access and Subacute Hospital EPICS Forms and Definitions

Ambulatory Surgical Hospital EPICS Forms and Definitions

Freestanding Facilities EPICS Forms and Definitions

Nursing Homes EPICS Forms and Definitions

Psychiatric Hospitals EPICS Forms and Definitions

Rehabilitation Hospitals EPICS Forms and Definitions

Continuing Care Retirement Communities EPICS Forms and Definitions

Parent Companies EPICS Forms and Definitions

A. The methodology set forth in this chapter is market oriented. Consumers and buyers of health care will receive information from the board that will allow them to make prudent health care decisions.

B. Nothing in this chapter or the actions taken by the board pursuant to any of its provisions shall be construed as constituting approval by the Commonwealth or any of its agencies or officers of the reasonableness of any charges made or costs incurred by any health care institution.

C. The board will collect, analyze, and publish information on health care institutional provider practices relating to efficiency and productivity.

Each health care institution, except where otherwise indicated, will submit an annual historical performance filing. Each health care institution will submit an annual historical performance filing as prescribed in § 32.1-276.7 of the Code of Virginia. This filing will be used to collect audited financial information and other information for all of the categories listed in 12VAC5-216-40. It will provide the basis for the evaluation by the board. The annual historical performance filing shall be received by the board within 120 days after the close of the health care institution's fiscal year.

In compliance with § 32.1-276.4 B of the Code of Virginia, information that is collected by other public and private entities that is used by the board in its evaluation of efficiency and productivity shall be received by the board directly from the appropriate agency or entity. Data will also be drawn from the Virginia Patient Level Data System and from other available data bases.

Information concerning charges, costs, elements of costs, productivity, resource utilization, financial viability, and community support services will be assembled from the filings made pursuant to this chapter.

Individual data elements from the general categories identified in 12VAC5-216-40 will be used to form ratio indicators. These indicators will be used to evaluate health care institutions and rank health care institutions in relation to their peers.

1. Case mix index. Each acute care hospital shall provide the board with a case mix index for all inpatients and designated categories of inpatients when it submits its annual historical performance filing. The Medicare DRG grouper process shall be utilized by the board.

2. Each nursing facility that has received a Patient Intensity Rating System (PIRS) Service Intensity Index (SII) number from the Virginia Department of Medical Assistance Services shall report the four quarterly final PIRS SII scores associated with its fiscal year. These scores are to be reported on the institution's annual historical performance filing.

A. Information shall be submitted electronically.

B. Information shall be submitted using software developed by the board for the use of health institutions in submitting filings.

C. Any health care institution that does not have the computer equipment to submit electronically may apply to the board for an exemption to subsection B of this section. A fee commensurate with the cost of data entry will be assessed by the board.

The board will publish an annual report which will incorporate the data collected and analysis of the data including, but not limited to, an evaluation of the relative efficiency and productivity of health care institutions. An electronic data base is open to the public.

The performance of each health care institution will be measured using the indicators referenced in 12VAC5-216-50.

A. Unless exempted as provided for in 12VAC5-216-100, each health care institution will be subject to a ranking procedure.

1. Geographical peer grouping. Similar types of health care institutions (e.g., all hospitals or all nursing homes) will be grouped into geographical peer groups and ranked in relation to other institutions within their peer group.

2. Ranking procedure. Each health care institution will be ranked on each indicator and given a quartile score on each indicator. Each quartile represents 25% of institutions within the peer group. Each institution will be given a score of 1, 2, 3, or 4 on each indicator depending upon the quartile in which it falls. A quartile score of 1 on an indicator means that an institution ranked in the top quartile (top 25%) on that indicator. Quartile scores are summed over all indicators. The total is divided by the number of indicators to get an average quartile score. The top performers will be selected by using the average quartile score and identifying, to the extent possible, the top 25% of the institutions within each peer group.

B. Health care institutions may be sorted into other peer groupings (e.g., bed size, urban/rural, system/nonsystem) for purposes of analysis.

Until such time as a resource utilization adjustor, similar to the case mix index for acute care hospitals referenced in subdivision 1 of 12VAC5-216-50 is developed and adopted by the board, some institutions will be exempt from the ranking procedure as described below:

1. Psychiatric hospitals.

2. Rehabilitation hospitals.

3. Ambulatory surgery hospitals.

4. Continuing care retirement communities.

5. Children's specialty hospitals.

6. Subacute care hospitals.

Hospital Historical Filing, 03-01 (rev. 4/30/96).

Indicator Definitions – Acute Care Hospitals (rev. 10/15/96).

Special Services Utilization Calculations

Ambulatory Surgical Hospital Historical Filing, 03-02 (rev. 4/30/96).

Indicator Definitions – Ambulatory Surgery Hospitals (rev. 10/15/96).

Nursing Home Historical Filing, 03-03 (rev. 4/30/96).

Indicator Definitions – Nursing Homes (rev. 10/15/96).

Psychiatric Hospital Historical Filing, 03-05 (rev. 4/30/96).

Indicator Definitions – Psychiatric Hospitals (rev. 10/15/96).

Rehabilitation Hospital Historical Filing, 03-06 (rev. 4/30/96).

Indicator Definitions – Rehabilitation Hospitals (rev. 10/15/96).

Income Statement Reconciliation Worksheet, 04-04 (rev. 4/30/96).