Document Title: Title XIX State Plan Amendment (SPA)
12-017.
Subject: State plan changes related to payments for trauma care services under managed care and the emergency and trauma care support pool.
Effective Date: July 1, 2012.
Description: The health care authority (HCA) currently makes supplemental payments to trauma care providers for services to medicaid fee-for-service (FFS) clients who meet or exceed specified injury severity scores (ISS). Trauma care services provided to medicaid managed care enrollees are excluded from these supplemental payments. The nonfederal share of these supplemental payments for trauma care come from the trauma care fund (TCF), a dedicated trust account created by the legislature in 1997 to help offset the high cost to providers of operating and maintaining the statewide trauma care system.
Beginning July 1, 2012, over seventy percent of medicaid clients will be served by managed care organizations, including FFS populations who account for the bulk of cases qualifying for the trauma supplemental payment program. To reflect this medicaid population shift to managed care, the HCA is proposing to add language to the state plan allowing supplemental payments for qualified trauma care services provided to medicaid clients enrolled in managed care who meet published trauma program criteria. Consistent with this policy change, the HCA is amending WAC 182-550-5450 and 182-531-2000. See WSR 12-07-074.
In addition, the HCA is proposing to create an emergency and trauma care support pool (the "pool") for the purpose of maintaining support payments to Level I, II and III trauma care hospitals for trauma care services to medicaid clients, and to defined major air ambulance providers, i.e., Airlift Northwest. Base payments for hospital and air ambulance services are included in the managed care capitation rates, but trauma supplemental payments are not. To ensure adequate compensation reaches the critical trauma care providers, HCA proposes to direct "pool" resources (TCF and federal matching funds for hospitals) specifically to eligible Level I, II and III hospitals using the distribution method approved under the state plan (and outside the capitation rate). HCA proposes to make direct supplemental payments to Airlift Northwest using the same methodology authorized under the state plan. The HCA is applying to the Centers for Medicare and Medicaid Services (CMS) for authority to implement these proposals under a Section 1115 Demonstration Waiver.
The HCA will pay for eligible trauma care physician services through the managed care plans (enhanced rates are factored into the capitation rates).
HCA's proposed changes are budget-neutral.
For additional information, contact Sandy Stith, Office of Hospital Finance, P.O. Box 45500, Olympia, WA 98504, phone (360) 725-1949, TDD/TTY 1-800-848-5429, fax (360) 753-9152, e-mail sandy.stith@hca.wa.gov.