PROPOSED RULES
Original Notice.
Preproposal statement of inquiry was filed as WSR 01-10-132.
Title of Rule: Trauma enhanced reimbursement.
Purpose: To allow for accessing federal matching funds for trauma reimbursement to ambulances, physicians, and clinicians.
Statutory Authority for Adoption: RCW 70.168.040 Emergency medical services and trauma care system trust account.
Statute Being Implemented: RCW 70.168.040 Emergency medical services and trauma care system trust account.
Summary: The proposed rule amendments add two more ways for trauma service providers to receive reimbursement monies and allows the maximum amount of federal funds to be available to the Washington trauma system.
Reasons Supporting Proposal: By amending WAC 246-976-935 this would increase the amount of funds channeled into the Washington trauma system and allow for reimbursement to those entitled as intended by the legislature when the trust account was established.
Name of Agency Personnel Responsible for Drafting: Dolly Fernandes, 2725 Harrison Avenue N.W., Suite 500, Olympia, WA 98504-7853, (360) 705-6718; Implementation and Enforcement: Prehospital - Dolly Fernandes, (360) 705-6718 and Physician - Chris Williams, (360) 705-6735, 2725 Harrison Avenue N.W., Suite 500, Olympia, WA 98504-7853.
Name of Proponent: Department of Health, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: WAC 246-976-935 has been established to disburse funds from the trauma reimbursement fund to allow for reimbursement of hospitals and health care providers for costs incurred while caring for uninsured or underinsured major trauma patients. The rules identify who is eligible to receive funding, and provide a framework for methods of distribution of the funds. At present, these rules limit the trauma enhanced reimbursement payments to prehospital services only through grants, and reimbursement only to services provided on the initial hospitalization.
The proposed rule changes add two more ways for trauma service providers to receive reimbursement monies and allows the maximum amount of federal funds to be available to the Washington trauma system.
Proposal Changes the Following Existing Rules: The proposed rules for prehospital services will allow the prehospital services to either receive the grant or get the federal participation matching funds when they transport Medical Assistance Administration (MAA) patients. The proposed rules for designated trauma service providers will allow these providers to get reimbursed for trauma care services provided within six months of the date of injury for any diagnosis related to the traumatic event.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The rule has been reviewed and analyzed, and there is not a disproportionate impact between large and small agencies, and it will not impose more than minor costs on businesses. Instead, this rule adds two more ways for trauma service provides to receive reimbursement monies and allows the maximum amount of federal funds to be available to the Washington trauma system.
RCW 34.05.328 applies to this rule adoption. These rules are significant because (1) they subject program ineligibility for not complying with the rule and (2) the rule establishes qualifications or processes for program eligibility. A significant rule analysis is available in the rule-making file.
Hearing Location: Department of Health, 1101 Eastside Street, Olympia, WA, on December 14, 2001, at 9:00 a.m.
Assistance for Persons with Disabilities: Contact Tami Schweppe by December 7, 2001, TDD (800) 833-6388 or (360) 705-6748.
Submit Written Comments to: Dolly Fernandes, Department of Health, EMS and Trauma Prevention, P.O. Box 47853, Olympia, WA 98504-7853, fax (360) 705-6706, by December 7, 2001.
Date of Intended Adoption: January 21, 2002.
October 29, 2001
Mary C. Selecky
Secretary
OTS-5233.1
AMENDATORY SECTION(Amending WSR 98-05-035, filed 2/10/98,
effective 3/13/98)
WAC 246-976-935
Emergency medical services and trauma care
system trust account.
RCW 70.168.040 establishes the emergency
medical services and trauma care system trust account. With the
advice of the EMS/TC steering committee, the department will
develop a method to budget and distribute funds in the trust
account. The department may use an injury severity score to
define a major trauma patient. Initially, the method and budget
will be based on the department's Trauma Care Cost Reimbursement
Study, final report (October 1991). The committee and the
department will review the method and the budget at least every
two years.
(1) Definitions: The following phrases used in this section mean:
(a) "Initial acute episode of injury" refers to care that is
related to a major trauma. This can include prehospital care,
resuscitation, stabilization, inpatient care and/or subsequent
transfer, and rehabilitation. It does not include ((outpatient
care or)) later readmission or outpatient care.
(b) "Needs grant" is a trust account payment that is based on a demonstrated need to develop and maintain service that meets the trauma care standards of chapter 70.168 RCW and this chapter. Needs grants are awarded to verified trauma care ambulance or aid services. Services must be able to show that they have looked for other resources without success before they will be considered for a needs grant.
(c) "Participation grant" refers to a trust account payment designed to compensate the recipient for participation in the state's comprehensive trauma care system. These grants are intended as a tool for assuring access to trauma care. Participation grants are awarded to:
(i) Verified trauma care ambulance or aid services;
(ii) Designated trauma care services; and
(iii) Designated trauma rehabilitation services.
(2) The department will distribute trust account funds to:
(a) Verified trauma care ambulance and aid services;
(b) Designated trauma care services:
(i) Levels I-V general; and
(ii) Levels I-III pediatric;
(c) Physicians and other clinical providers who:
(i) Are members of designated trauma care services;
(ii) Meet the response-time standards of this chapter;
(iii) Provide care for major trauma patients during the initial acute episode of injury. This includes physiatrists who consult on rehabilitation during the acute hospital stay, or who provide care in a designated trauma rehabilitation service;
(iv) Complete trauma records in a timely manner according to the trauma care services current requirements; and
(v) Participate in quality assurance activities;
(d) Designated trauma rehabilitation services:
(i) Levels I-III; and
(ii) I-pediatric.
(3) The department's distribution method for verified trauma care ambulance and aid services will include at least:
(a) Participation grants, which will be awarded once a year
to services that comply with verification standards. ((The
department will review the compliance requirements annually;))
Services that are eligible to receive Medicaid funds will have
the option of either receiving the participation grant or
receiving an increased payment by the department of social and
health services for medical emergency transportation of medical
assistance clients who meet trauma triage criteria;
(b) Needs grants, based on the service's ability to meet the standards of chapter 70.168 RCW and chapter 246-976 WAC (this chapter). The department may consider:
(i) Level of service (BLS, ILS, ALS);
(ii) Type of service (aid or ambulance);
(iii) Response area (rural, suburban, urban, wilderness);
(iv) Volume of service;
(v) Other factors that relate to trauma care;
(4) The department's distribution method for designated trauma care services, levels I-V general and I-III-pediatric will include at least:
(a) Participation grants, which will be awarded once a year only to services that comply with designation standards. The department will review the compliance requirements annually. The department may consider:
(i) Level of designation;
(ii) Service area (rural, suburban, urban, wilderness);
(iii) Volume of service;
(iv) The percentage of uncompensated major trauma care;
(v) Other factors that relate to trauma care;
(b) Increased payment by the department of social and health services for major trauma care for medical assistance clients during the initial acute episode of injury;
(5) The department's distribution method for physicians and other clinical providers included in subsection (2)(c) of this section will include at least:
(a) Increased payment by the department of social and health
services for trauma care ((and rehabilitation)) of medical
assistance clients and care provided within six months of the
date of injury for inpatient surgical procedures related to the
injury, which were planned during the initial acute episode of
injury, using Medicare rates as a benchmark;
(b) Partial reimbursement for care of other major trauma patients who meet DOH eligibility criteria. The department's criteria will consider at least:
(i) The patient's ability to pay;
(ii) The patient's eligibility for other health insurance, such as medical assistance or Washington's basic health plan;
(iii) Other sources of payment.
(6) The department's distribution method for designated trauma rehabilitation services, levels I-III and I-pediatric will include at least:
(a) Participation grants, which will be awarded once a year only to services that comply with designation standards. The department will review the compliance requirements annually. The department may consider:
(i) Level of designation;
(ii) Volume of service;
(iii) Other factors that relate to trauma care;
(b) Partial reimbursement for trauma rehabilitation provided during the initial acute episode of injury for major trauma patients who:
(i) Meet DOH eligibility criteria. The department's criteria will include at least:
(A) Residence in Washington at the time of injury;
(B) The patient's ability to pay;
(C) The patient's eligibility for other health insurance, such as medical assistance or Washington's basic health plan;
(D) Other sources of payment;
(ii) Were admitted for rehabilitation service within ninety days of the injury;
(c) The department will give priority to acute inpatient rehabilitation services.
(7) Chapter 70.168 RCW requires regional match of state funds from the emergency medical services and trauma care trust account. Contributions to regional matching funds may include:
(a) Hard match;
(b) Soft match:
(i) The value of services provided by volunteer prehospital agencies;
(ii) Local government support;
(iii) The cost of care by designated trauma care services which exceeds insurance or patient payment;
(iv) The value of volunteer time (excluding any expenses paid with state funds) to establish and operate:
(A) State EMS/TC committees and their subcommittees;
(B) Regional and local EMS/TC councils, and their committees and subcommittees;
(C) Regional and local quality assurance programs;
(D) Injury prevention and public education programs;
(E) EMS training and education programs;
(F) Trauma-related stress management and support programs;
(c) The department will determine the value of personnel time included in soft match, to be applied statewide.
[Statutory Authority: Chapter 70.168 RCW. 98-05-035, 246-976-935, filed 2/10/98, effective 3/13/98.]