WSR 12-09-078



[ Filed April 17, 2012, 3:48 p.m. ]


Document Title: Establishment of an Emergency and Trauma Care Support Pool Under Section 1115 (a)(2) of the Social Security Act.

Subject: Supplemental payments to designated trauma hospitals and Airlift Northwest.

Effective Date: July 1, 2012.

Description: The health care authority (HCA), through its major trauma program, makes supplemental payments to trauma care providers for medicaid fee-for-service (FFS) clients who meet or exceed specified injury severity scores (ISS). Managed care plans currently do not receive supplemental payments for trauma care services provided to medicaid managed care clients. The nonfederal share of these supplemental payments is funded through the trauma care fund (TCF), a dedicated trust account established by the legislature in 1997 to support the statewide trauma care system. In addition, the Washington medicaid program provides supplemental medicaid payments through the FFS program to cover unreimbursed costs of services provided by defined major air ambulance providers - specifically, Airlift Northwest.

On July 1, 2012, a substantial number of medicaid FFS clients will be shifted to managed care, resulting in over seventy percent of medicaid clients being served under managed care. The HCA is proposing to create an emergency and trauma care support pool for the purpose of maintaining support for eligible trauma care hospitals and major air ambulance providers for services to medicaid clients, currently provided through the FFS program, as the medicaid program increasingly moves to managed care.

The HCA will amend WAC 182-550-5450 and 182-531-2000 to allow supplemental payments to trauma care providers for clients in managed care, effective with dates of service on and after July 1, 2012. Notice of this proposed action was published in the Washington State Register as WSR 12-07-074 on April 4, 2012.

The HCA will also apply to the Centers for Medicare and Medicaid Services (CMS), under the authority of Section 1115 (a)(2) of the Social Security Act, to authorize federal matching funds for the new pool for the five year period from July 1, 2012, through June 30, 2017. The HCA will request authority to receive federal medicaid matching funds for trauma supplemental payments made directly to providers through the new pool and outside the managed care capitation rate. CMS approval of this request will prevent the loss of up to $7.5M per year in federal matching funds from the statewide trauma care system. The HCA will also ask for CMS approval to continue providing federal funding for direct supplemental payments to Airlift Northwest for emergency air ambulance transports, now through the new pool.

HCA will request from CMS the following specific authorities:

HCA will request authority for expenditures for the emergency and trauma care support pool to be regarded as expenditures under the state's medicaid plan for the five year period.
No specific waiver authority is necessary.

The HCA hypothesizes that the funding provided through the demonstration will enable the continued availability and effectiveness of critical trauma services and air ambulance services for medicaid beneficiaries, and will monitor the programs accordingly.

Aggregate spending on both the trauma care and air ambulance portions of the emergency and trauma care support pool will be no greater than it would have been without the demonstration. No additional state general revenue funding will be required.

Copies of the Section 1115 demonstration application will be available at HCA's web site for public review and comment. WSR 12-07-074 is available at

The HCA also reported and received public input on the proposal at the following public meetings:

Title XIX advisory committee meeting in Seattle on March 23, 2012;
Emergency medical services and trauma care steering committee meeting in Kent on March 21, 2012; and
AIHC-HCA tribal workgroup meeting in Olympia on March 14, 2012.

For additional information, contact Sandy Stith, Hospital Finance Officer, HCA, Office of Hospital Finance, P.O. Box 45510, Olympia, WA 98504-5510, phone (360) 725-1949, TDD/TTY 1-800-848-5429, fax (360) 753-9152, e-mail

Washington State Code Reviser's Office