Current through Vol. 42, No. 1, September 16, 2024
(a) There shall be
a minimum of two filing periods annually with such filing periods to be
designated by the Department. By the end of each filing period, each
distribution entity requesting distribution of a pro rata share of the Trauma
Care Assistance Revolving Fund shall file a report with the Commissioner for
the designated filing period.
(b)
Each distribution entity shall use the forms established by OAC
310:669-5-2 to
report the following:
(1) A link(s) to
identify the trauma registry data;
(2) The dollars of gross revenues for the
distribution entity's trauma care bad debts;
(3) The dollars of gross revenues for the
distribution entity's trauma charity care;
(4) The cost to charge ratio calculated using
the costs and charges for all departments of a trauma facility; and
(5) The trauma facility's specific ambulance
department cost to charge ratio for a hospital-based ambulance
service.
(c) Trauma
reported to the trauma registry is described by one of the following:
(1) An ICD-9 code of 800.00 to 959.9, and is
limited to contacts within thirty (30) days of the injury, and is accompanied
by one or more of the following events for the patient:
(A) An admission to a hospital of at least
forty-eight (48) hours; or
(B)
Transfer from a lower level to a higher level of trauma care for major trauma;
or
(C) Admission to an intensive
care unit; or
(D) Admission
directly to an operating room for surgery of the head, chest, abdomen, or
vascular system; or
(E) A
declaration of dead on arrival; or
(F) A declaration of dead in the emergency
room or elsewhere in the hospital.
(G) In addition to meeting the requirements
at 310:669-5-1(c), each reportable case must also meet at least one of the
following criteria as computed by the trauma registry software, unless the
patient was declared dead on arrival to the hospital or died while in the
hospital:
(i) Have an Abbreviated Injury
Score of 3 or higher; or
(ii) Have
an Injury Severity Score of 9 or higher; or
(iii) Have a Survival Probability of 0.90 or
less; or
(2)
Oral-maxillo-facial injuries requiring the immediate treatment and presence of
a licensed physician or licensed dentist credentialed by the hospital to
perform oral-maxillo-facial surgery, with an ICD-9 code of 800.0 to 959.9 and
meeting at least one of the following criteria:
(A) Panfacial trauma involving fractures of
the zygomaticomalar complex type, or a Lefort type (I, II, or III) and a
mandibular fracture. Panfacial trauma may also include multiple soft tissue
injuries, lacerations, or avulsions; or
(B) Bilateral fracture of the mandible with
flail symphyseal segment; or
(C)
Multiple severe mandibular fractures requiring tracheostomy or intubation of
greater than 24 hours; or
(D)
Depressed zygomaticomalar complex fractures with entrapment of the inferior
rectus muscle or impingement on the optic nerve bundle; or
(E) Facial lacerations that involve major
vessels, major branches of the facial nerve, or the parotid duct; or
(3) Traumatic injuries to the hand
requiring the immediate presence and treatment by a physician credentialed by
the hospital with ICD-9 codes of 800.00 to 959.9 and meeting one of the
following criteria:
(A) Complete amputations
or lacerations of the hand which result in disruption of the vascular supply to
one or more digits or the entire hand; or
(B) Severely crushed or mangled hand injuries
with associated vascular injuries, fractures and/or dislocations.
(d) Time sensitive
traumatic injuries requiring immediate surgical intervention by a surgical
specialist to prevent loss of life, limb, or vision, and not meeting the
criteria identified in 310:669-5-1(c) may be considered for Trauma Fund
Disbursement as approved by the Medical Audit Committee and the Oklahoma Trauma
System Improvement and Development Advisory Council and reported to the Board
of Health. Such approval shall occur periodically and shall not be effective
retroactively.
(e) Cases meeting
any of the following exclusionary conditions shall not be reported to the
trauma registry or be eligible for reimbursement from the Fund:
(1) Isolated orthopedic injuries to the
extremities due to a same level fall;
(2) Overexertion injuries;
(3) Injuries resulting from a pre-existing
condition such as osteoporosis or esophageal stricture;
(4) Injuries greater than 30 days
old;
(5) Poisoning and toxic
events; and
(6) Submersion
injuries.
(f)
Uncompensated expenses incurred by a distribution entity associated with major
trauma patients, and such trauma care has been reported to the state
pre-hospital emergency medical service database and/or the state trauma
registry, shall be eligible for reimbursement. Uncompensated expenses incurred
for emergency transport to a trauma facility from the scene of the injury or
from a lower level to a higher level of trauma care are eligible for
reimbursement when the case meets one or more of the following conditions:
(1) The extent of patient injury is verified
through a hospital trauma registry as described at OAC
310:667-5-1(c),
(d), and (e); or
(2) Glascow coma score equal to or less than
thirteen (13) directly related to the mechanism of injury; or
(3) Signs and symptoms of respiratory
compromise resulting from trauma requiring intervention; or
(4) Hemodynamic compromise from trauma
resulting in decreased blood pressure; or
(5) Penetrating injury above the groin;
or
(6) Amputation proximal to the
wrist or ankle; or
(7) Complete
amputations or lacerations of the hand which result in disruption of the
vascular supply to one or more digits or the entire hand; or
(8) Severely crushed or mangled hand injuries
with associated vascular injuries, fractures and/or dislocations.
(9) Paralysis resulting from traumatic
injury, including pre-hospital treatment for spinal precautions based upon the
signs and symptoms of neurological deficit; or
(10) Flail chest; or
(11) Two or more proximal long bone fractures
(humerus and/or femur); or
(12)
Open or depressed skull fracture; or
(13) Unstable pelvis; or
(14) Pediatric trauma score equal to or less
than eight (8).
(15) Time sensitive
traumatic injuries requiring immediate surgical intervention by a surgical
specialist to prevent loss of life, limb, or vision, and not meeting the
criteria identified in 310:669-5-1(c) and approved by the Medical Audit
Committee and the Oklahoma Trauma System Improvement and Development Advisory
Council and reported to the Board of Health.
(g) A distribution entity shall exclude from
its contractual adjustments gross revenue amounts written off as a result of
governmental payors' set reimbursement rates that are not subject to
negotiation by the entity. Contractual adjustment exclusions may include but
are not limited to Medicare, Medicaid, and Indian Health Service
reimbursement,and shall not include Workers Compensation.
(h) A free-standing ambulance service shall
calculate transportation reimbursement using the Centers for Medicare and
Medicaid Services reimbursement methodology in place as of the date of
transportation.
(i) A physician
shall calculate procedure reimbursement using the Centers for Medicare and
Medicaid Services reimbursement methodology based on the appropriate procedure
code.
(j) A distribution entity
shall not include in uncompensated care any deductible or coinsurance that the
patient fails to pay to the distribution entity unless the distribution entity
has pursued reasonable collection efforts consistent with those generally used
by similar entities. A distribution entity shall not include any amount it is
not entitled to collect from the patient.
(k) If a trauma facility transfers a major
trauma patient to another facility classified to provide a higher level of
trauma care, the transfer shall be performed in accordance with the Oklahoma
Triage, Transport, and Transfer Guidelines established under OAC
310:641-3-130(b)(3).
The transferring facility shall include in uncompensated care reported in
accordance with OAC
310:669-5-2 only
those gross revenues incurred which were necessary to provide stabilizing
treatment prior to effecting an appropriate transfer. Gross revenues for
inappropriate definitive diagnostic testing prior to transfer shall not be
reported as uncompensated care.
Added at 17 Ok Reg 3465,
eff 8-29-00 (emergency); Added at 18 Ok Reg 2047, eff 6-11-01; Amended at 19 Ok
Reg 393, eff 11-19-01 (emergency); Amended at 19 Ok Reg 1064, eff 5-13-02;
Amended at 20 Ok Reg 1665, eff 6-12-03; Amended at 21 Ok Reg 2440, eff 7-11-05;
Amended at 24 Ok Reg 2025, eff 6-25-07
