Part II. Application
12VAC5-221-65. Reimbursement.
A. For each application recommended for approval by the authority, a review deposit of $50,000 shall be paid by the applicants to the department.
B. The review deposit shall be:
1. Remitted only by certified check, cashier's check, bank money order, or other methods approved by the commissioner;
2. Made payable to the department; and
3. Due to the department upon the commissioner's receipt of a recommendation for approval from the authority.
C. If the commissioner determines, after review of the application, that the actual cost incurred by the department is less than $50,000, the department shall reimburse the applicant the amount that is greater than the actual cost.
D. If the commissioner determines that the actual cost incurred by the department is greater than $50,000, the applicant shall pay any additional amount to be:
1. Remitted only by certified check, cashier's check, bank money order, or other methods approved by the commissioner;
2. Made payable to the department; and
3. Due to the department 30 days after receipt of a request for payment from the commissioner.
E. The commissioner shall:
1. Incur only those costs necessary to adequately review the application as determined in the commissioner's sole discretion; and
2. Maintain detailed records of all costs incurred for which reimbursement is sought.
F. An applicant seeking approval of a cooperative agreement shall reimburse the commissioner for all reasonable and actual costs incurred by the commissioner in the commissioner's review of the application, including costs of experts and consultants retained by the commissioner.
G. The applicants shall make payment to the department within 30 days of receipt of a request for reimbursement.
H. Prior to contracting with experts or consultants, the commissioner shall provide a seven-day notice to the applicants describing the proposed scope of work and anticipated costs of those experts and consultants.
I. The applicants shall have seven days from the date of receipt of the commissioner's notice pursuant to subsection H of this section to provide to the commissioner possible alternatives to the use of those experts and consultants.
J. The commissioner shall consider information submitted by the applicants in determining whether to retain an expert or consultant.
K. All reimbursement requests by the commissioner shall be subject to the provisions of § 2.2-4805 of the Code of Virginia.
Statutory Authority
§ 32.1-12 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 42, Issue 8, eff. January 15, 2026.
12VAC5-221-95. Conditions.
The commissioner may condition the approval of the authorization letter on the applicant's commitment to achieving improvements to population health, access to health care services, quality, and cost-effectiveness identified by the applicant in support of the application. The conditions may include:
1. A cap on the negotiated case-mix adjusted revenue per discharge by payer by product;
2. A commitment to return a portion of the cost savings and efficiencies gained through the cooperative agreement to residents in the participating localities through specific proposed mechanisms;
3. An agreement that the parties may not prevent or discourage health plans from directing or incentivizing patients to choose certain providers;
4. An agreement that the parties may not have any contractual clauses or provisions that prevent health plans from directing or incentivizing patients;
5. An agreement that the parties may not engage in the typing of sales of the health system's services with the health plan purchase of other services from the health system;
6. An agreement that the parties may not restrict a health plan's ability to make available to its health plan enrollees cost, quality, efficiency, and performance information to aid enrollees in evaluating and selecting providers in the health plan;
7. A commitment that the parties may not refuse to include certain provisions in contracts with health plans that have been utilized in health plan contracts in other parts of the Commonwealth in order to promote value-based health care, including bundled payments, pay for performance, utilization management, and other processes that reward improvements in quality and efficiency; and
8. A commitment to reduce the total cost of care and improve the quality of care in the region served by the new entity.
Statutory Authority
§ of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 42, Issue 8, eff. January 15, 2026.