WSR 98-01-164

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed December 22, 1997, 4:03 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-21-136.

Title of Rule: EMS and trauma care system trust account--Disbursement (pursuant to SB 5127 amending chapter 70.168 RCW).

Purpose: To disburse funds in the trust account. "Emergency medical services and trauma care are provided to all residents of the state regardless of a person's ability to pay. Historically, hospitals and health care providers have been able to recover some of their financial losses incurred in caring for an uninsured or underinsured person by charging persons able to pay more. In recent years, the health care industry has undergone substantial changes. With the advent of managed health care programs and the adoption of new cost control measures, some hospitals and health care providers assert that it is difficult to shift costs for uninsured and underinsured patients onto insured patients." (Chapter 70.168 RCW).

Statutory Authority for Adoption: Chapter 70.168 RCW and SB 5127 (1997).

Statute Being Implemented: Chapter 70.168 RCW.

Summary: The rules provide a framework for the Department of Health to disburse the EMS and trauma care fund to providers of trauma care.

Reasons Supporting Proposal: The proposal is in response to a legislative requirement.

Name of Agency Personnel Responsible for Drafting: Shane Sanderson, 2725 Harrison Avenue N.W., Olympia, WA, (360) 705-6727; and Implementation: Janet Griffith, 2725 Harrison Avenue N.W., Olympia, WA, (360) 705-6745.

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: This rule provides a framework for distribution of the EMS and trauma care system fund established in chapter 70.168 RCW.

Trauma care providers (EMS agencies, hospitals, physicians, etc.) will be compensated, at least in part, for providing care to trauma patients, without regard to the patient's ability-to-pay. This will encourage providers to participate in an organized response to trauma situations. The department will use three methods to distribute funds:

Payment to providers of major trauma care for the Department of Social and Health Services medical assistance clients and for certain other patients who meet the Department of Health-defined eligibility criteria.

"Participation grants" to compensate services for their availability to the comprehensive trauma care system, in order to assure access to trauma care.

"Needs grants" to prehospital agencies that are otherwise not able to meet RCW and WAC standards.

Reimbursement for uncompensated trauma care will help to assure the availability of all components needed for a comprehensive trauma system in all parts of the state.

Proposal does not change existing rules.

No small business economic impact statement has been prepared under chapter 19.85 RCW. These rules do not impose an economic burden on any small businesses.

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: 1101 Eastside Street, Room 16, Olympia, WA, on January 27, 1998, at 9:00 a.m.

Assistance for Persons with Disabilities: Contact Tami Schweppe by January 16, 1998, TDD (800) 833-6388, or (360) 705-6748.

Submit Written Comments to: Janet Griffith, Director, P.O. Box 47853, Olympia, WA 98504-7853, FAX (360) 705-6706, by January 16, 1998.

Date of Intended Adoption: January 27, 1998.

December 22, 1997

Bruce Miyahara

Secretary

EMERGENCY MEDICAL SERVICES AND TRAUMA CARE SYSTEM TRUST ACCOUNT

NEW SECTION

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.

(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;

(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, 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 state-wide.

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