Administrative Code

Virginia Administrative Code
5/30/2024

Part III. Filing Requirements and Fee Structure

12VAC5-215-50. Annual historical filing.

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other income, other outlays, assets and liabilities, units of service, and related statistics as prescribed in § 9-158 (Repealed) of the Code of Virginia on forms provided by the board together with unconsolidated certified audited financial statements.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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.1, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-60. Schedule of charges.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.4, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-70. Survey of rates.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.5, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-80. Commercial diversification survey.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.6, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-90. Affiliates.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.6:1, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-100. Financial statement (healthcare institution).

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.6:5, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-110. Deadline.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.6:6, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-120. IRS Forms.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.7, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-130. Filing.

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

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.8, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-140. Fees.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.9, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-150. Schedule.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.10, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

12VAC5-215-160. Late fees.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 et seq. of the Code of Virginia.

Historical Notes

Derived from VR370-01-001 § 4.11, eff. February 25, 1987; amended, Virginia Register Volume 5, Issue 12, eff. April 12, 1989; Volume 6, Issue 15, eff. July 1, 1990; Volume 7, Issue 10, eff. April 1, 1990; Volume 8, Issue 1, eff. January 1, 1992; Volume 8, Issue 13, eff. January 1, 1992; Volume 8, Issue 17, eff. July 1, 1992; Volume 8, Issue 21, eff. September 1, 1992; Volume 8, Issue 26, eff. November 1, 1992; Volume 9, Issue 12, eff. April 7, 1993; Volume 10, Issue 15, eff. June 1, 1994; renumbered and amended, Virginia Register Volume 13, Issue 4, eff. December 11, 1996.

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