Current through Reg. 49, No. 38; September 20, 2024
(a) Definitions. The following words and
terms, when used in this section, shall have the following meanings, unless the
context clearly indicates otherwise.
(1)
Extraordinary emergency--An event or situation which may disrupt the services
of an EMS/trauma system.
(2) Rural
county--A county with a population of less than 50,000 based on the latest
official federal census population figures.
(3) Urban county--A county with a population
of 50,000 or more based on the latest official federal census population
figures.
(4) Emergency
transfer--Any immediate transfer of an emergent or unstable patient, ordered by
a licensed physician, from a health care facility to a health care facility
which has the capability of providing a higher level of care or of providing a
specialized type of care not available at the transferring facility.
(5) Trauma care--Care provided to patients
who underwent treatment specified in at least one of the following ICD-9
(International Classification of Diseases, 9th Revision, of the National Center
of Health Statistics) codes: between 800.00 and 959.9, including 940.0-949.0
(burns), excluding 905.0-909.0 (late effects of injuries), 910.0-924.0
(blisters, contusions, abrasions, and insect bites), 930.0-939.0 (foreign
bodies), and who underwent an operative intervention as defined in paragraph
(9) of this subsection or was admitted as an inpatient for greater than
23-hours or who died after receiving any emergency department evaluation or
treatment or was dead on arrival to the facility or who transferred into or out
of the hospital.
(6) Uncompensated
trauma care--The sum of "charity care" and "bad debt" resulting from trauma
care as defined in paragraph (5) of this subsection after due diligence to
collect. Contractual adjustments in reimbursement for trauma services based
upon an agreement with a payor (to include but not limited to Medicaid,
Medicare, Children's Health Insurance Program (CHIP), etc.) is not
uncompensated trauma care.
(7)
Charity care--The unreimbursed cost to a hospital of providing health care
services on an inpatient or emergency department basis to a person classified
by the hospital as "financially indigent" or "medically indigent".
(A) Financially indigent--An uninsured or
underinsured person who is accepted for care with no obligation or a discounted
obligation to pay for the services rendered based on the hospital's eligibility
system.
(B) Medically indigent--A
person whose medical or hospital bills after payment by third-party payors (to
include but not limited to Medicaid, Medicare, CHIP, etc.) exceed a specified
percentage of the patient's annual gross income, determined in accordance with
the hospital's eligibility system, and the person is financially unable to pay
the remaining bill.
(8)
Bad debt--The unreimbursed cost to a hospital of providing health care services
on an inpatient or emergency department basis to a person who is financially
unable to pay, in whole or in part, for the services rendered and whose account
has been classified as bad debt based upon the hospital's bad debt policy. A
hospital's bad debt policy should be in accordance with generally accepted
accounting principles.
(9)
Operative intervention--Any surgical procedure resulting from a patient being
taken directly from the emergency department to an operating suite regardless
of whether the patient was admitted to the hospital.
(10) Calculation of the costs of
uncompensated trauma care--For the purposes of this section, a hospital will
calculate its total costs of uncompensated trauma care by summing its charges
related to uncompensated trauma care as defined in paragraph (6) of this
subsection, then applying the cost to charge ratio defined in paragraph (12) of
this subsection and derived in accordance with generally accepted accounting
principles.
(11) County of
licensure--The County within which lies the location of the business mailing
address of a licensed ambulance provider, as indicated by the provider on the
application for licensure form that it filed with the department.
(12) Cost-to-charge ratio--A hospital's
overall cost-to-charge ratio determined by the Health and Human Services
Commission from the hospital's Medicaid cost report. The hospital's latest
available cost-to-charge ratio shall be used to calculate its uncompensated
trauma care costs.
(b)
Reserve. On September 1 of each year, there shall be a reserve of $500,000 in
the emergency medical services (EMS) and trauma care system account and the
emergency medical services, trauma facilities, and trauma care system fund
(accounts) for extraordinary emergencies. During the fiscal year, distributions
may be made from the reserve by the commissioner of health based on requests
which demonstrate need and impact on the EMS and trauma care system (system).
Proposals not immediately recommended for funding will be reconsidered at the
end of each fiscal year, if funding is available, and need are still
present.
(c) Allotments. The EMS
allotment shall be 50%, the trauma service area (TSA) allotment shall be not
more than 20%, and the uncompensated care allotment shall be at least 27% of
the funds remaining from the accounts after any amount necessary to maintain
the extraordinary emergency reserve of $500,000 has been deducted.
(1) Allotment Determination. Each year, the
department shall determine:
(A) eligibility
of all EMS providers, regional advisory councils (RACs), and trauma
facilities;
(B) the amount of the
TSA allotment, the EMS allotment, and the uncompensated care
allotment;
(C) each county's share
of the EMS allotment for eligible recipients in the county;
(D) each RAC's share of the TSA allotment;
and
(E) each designated trauma
facility's share of the uncompensated care allotment.
(2) EMS Allotment. The department shall
contract with each eligible RAC to distribute the county shares of the EMS
allotment to eligible EMS providers based within counties which are aligned
within the relevant RAC. Prior to distribution of the county shares to eligible
providers, the RAC shall submit a distribution proposal, approved by the RAC's
voting membership, to the department for approval.
(A) The county portion of the EMS allotment
shall be distributed directly to eligible recipients without any reduction in
the total amount allocated by the department and shall be used as an addition
to current county EMS funding of eligible recipients, not as a
replacement.
(B) The department
shall evaluate each RAC's distribution plan based on the following:
(i) fair distribution process to all eligible
providers, taking into account all eligible providers participating in
contiguous TSAs;
(ii) needs of the
EMS providers; and
(iii) evidence
of consensus opinion for eligible entities.
(C) A RAC opting to use a distribution plan
from the previous fiscal year shall submit, to the department, a letter or
email of intent to do so.
(D)
Eligible EMS providers may opt to pool funds or contribute funds for a
specified RAC purpose.
(3) TSA Allotment. The department shall
contract with each eligible RAC to distribute the TSA allotment. Prior to
distribution of the TSA allotment, the RAC shall submit a budget proposal to
the department for approval. The department shall evaluate each RAC's budget
according to the following:
(A) budget
reflects all funds received by the RAC, including funds not expended in the
previous fiscal year;
(B) budget
contains no ineligible expenses;
(C) appropriate mechanism is used by RAC for
budgetary planning; and
(D) program
areas receiving funding are identified by budget categories.
(4) Uncompensated Care Allotment.
The department shall contract with each eligible RAC to distribute shares of
the uncompensated care allotment to eligible designated trauma facilities
within the RAC's TSA. Prior to distribution of the uncompensated care
allotment, the RAC shall submit a distribution proposal, approved by the RAC's
voting membership, to the department for approval.
(A) The department shall evaluate each RAC's
distribution plan based on the following:
(i)
fair distribution process to all eligible providers;
(ii) needs of designated trauma facilities;
and
(iii) evidence of consensus
opinion from eligible entities.
(B) A RAC opting to use a distribution plan
from the previous fiscal year shall submit, to the department, a letter or
email of intent to do so.
(C)
Eligible designated hospitals may opt to pool funds or contribute funds for a
specified RAC purpose for novel or innovative projects.
(d) Eligibility requirements. To
be eligible for funding from the accounts, all potential recipients (EMS
Providers, RACs, Registered First Responder Organizations and hospitals) must
maintain active involvement in regional system development. Potential
recipients must also meet requirements for reports of expenditures from the
previous year and planning for use of the funding in the upcoming year.
(1) Extraordinary Emergency Funding. To be
eligible to receive extraordinary emergency funding, an entity must:
(A) be a licensed EMS provider, a licensed
general hospital, or a registered first responder organization;
(B) submit to the department a signed written
request, containing the entity name, contact information, amount of funding
requested, and a description of the extraordinary emergency; and
(C) timely submit a signed and fully
completed extraordinary emergency information checklist (on the department's
form) to the department.
(2) EMS Allotment. To be eligible for funding
from the EMS allotment, an EMS provider must meet the following requirements:
(A) maintain provider licensure as described
in §
157.11
of this title (relating to Requirements for An EMS Provider License) and
provide emergency medical services and/or emergency transfers;
(B) demonstrate utilization of the RAC
regional protocols regarding patient destination and transport in all TSAs in
which they operate (verified by each RAC);
(C) demonstrate active participation in the
regional system performance improvement (PI) program in all TSAs in which they
operate (verified by each RAC);
(D)
if an EMS provider is licensed in a county or contracted to provide emergency
medical services in a county that is contiguous with a neighboring TSA, it must
participate on at least one RAC of the TSAs:
(i) participation on both RACs is
encouraged;
(ii) RAC participation
shall follow actual patient referral patterns;
(iii) an EMS provider, contracted to provide
emergency medical services within a county of any one TSA and whose county of
licensure is another county not in or contiguous with that TSA, must be an
active member of the RAC for the TSA of their contracted service area and meet
that RAC's definition of participation and requirements listed in subparagraph
(E)(i)-(vi) of this paragraph; and
(iv) it is the responsibility of an EMS
provider to contact each RAC in which it operates to ensure knowledge of the
provider's presence and potential eligibility for funding from the EMS
allotment related to that RAC's TSA;
(E) if an EMS provider is serving any county
beyond its county of licensure it must provide to the department evidence of a
contract or letter of agreement with each additional county government or
taxing authority in which service is provided:
(i) inter-facility transfer letters of
agreement and/or contracts, as well as mutual aid letters of agreement and/or
contracts, do not meet this requirement;
(ii) contracts or letters of agreement must
be dated and submitted to the department on or before August 31 of the
respective year, and be effective more than six months of the upcoming fiscal
year;
(iii) effective dates of the
contracts or letters of agreement should be provided;
(iv) EMS providers with contracts or letters
of agreement on file with the department which include contract service dates
that meet the required time period need not resubmit.
(v) EMS providers are responsible for
assuring that all necessary portions of their contracts and letters of
agreement have been received by the department; and
(vi) air ambulance providers must meet the
same requirements as ground transport EMS providers to be eligible to receive
funds from a specific county other than the county of licensure; and
(F) if an EMS provider is licensed
in a particular county and has a contract (with a county government or taxing
authority) for a service area which is a geopolitical subdivision (examples
listed below) whose boundary lines cross multiple county lines, it will be
considered eligible for the 911 EMS Allotment for all counties overlapped by
that geopolitical subdivision's boundary lines. A contract with every county
that composes the geopolitical subdivision is not necessary. And, the
eligibility of EMS providers, whose county of licensure is in a geopolitical
subdivision other than those listed in clauses (i)-(vi) of this subparagraph,
will be evaluated on a case-by-case basis.
(i) Municipalities.
(ii) School districts.
(iii) Emergency service districts
(ESDs).
(iv) Hospital
districts.
(v) Utility
districts.
(vi) Prison
districts.
(3) RAC Allotment. To be eligible for funding
from the RAC allotment, a RAC must:
(A) be
officially recognized by the department as described in §
157.123
of this title (relating to Regional Emergency Medical Services/Trauma
Systems);
(B) be incorporated as an
entity that is exempt from federal income tax under §501(a) of the United
States Internal Revenue Code of 1986, and its subsequent amendments, by being
listed as an exempt organization under §501(c)(3) of the code;
(C) submit documentation of ongoing system
development activity and future planning;
(D) have demonstrated that a regional system
performance improvement (PI) process is ongoing by submitting to the department
the following:
(i) lists of committee meeting
dates and attendance rosters for the RAC'S most recent fiscal year;
(ii) committee membership rosters which
included each member's organization or constituency; and
(iii) lists of issues being reviewed in the
system performance improvement meetings; and
(E) submit all required EMS allocation
eligibility items addressed in paragraph (2)(B)-(C) of this
subsection.
(4) To be
eligible to distribute the EMS, Uncompensated Care and TSA allotments, a RAC
must be incorporated as an entity that is exempt from federal income tax under
§501(a) of the Internal Revenue Code of 1986, and its subsequent
amendments, by being listed as an exempt organization under §501(c)(3) of
the code.
(5) Uncompensated Care
Allotment. To be eligible for funding from the Uncompensated Care allotment, a
hospital must be a department designated trauma facility or a Department of
Defense hospital that is a department designated trauma facility.
(A) To receive funding from the Uncompensated
Care allotment, an application must be submitted within the time frame
specified by the department and include the following:
(i) name of facility;
(ii) location of facility including mailing
address, city and county; and
(iii)
Texas Provider Identifier (TPI number) or accepted federal identification
number.
(B) The
application must be signed and sworn to before a Texas Notary Public by the
chief financial officer, chief executive officer and the chairman of the
facility's board of directors.
(C)
A copy of the application shall be distributed by Level I, II, or III
facilities to the trauma medical director and Level IV facilities to the
physician director.
(D) The
department may opt to use data from applications submitted by qualified
hospitals in accordance with §
157.131(d)(5)
of this title (relating to Designated Trauma Facility and Emergency Medical
Services Account) for the distribution of funds outlined in subsection (e)(3)
of this section.
(E) Additional
information may be requested at the department's discretion.
(e) Calculation
Methods. Calculation of county shares of the EMS allotment, the RAC shares of
the TSA allotment, and the TSA's share of the uncompensated care allotment.
(1) EMS allotment.
(A) Counties will be classified as urban or
rural based on the latest official federal census population figures.
(B) The EMS allotment will be derived by
adjusting the weight of the statutory criteria in such a fashion that, in so
far as possible, 40% of the funds are allocated to urban counties and 60% are
allocated to rural counties.
(C) An
individual county's share of the EMS allotment shall be based on its geographic
size, population, and number of emergency health care runs multiplied by
adjustment factors, determined by the department, so the distribution
approximates the required percentages to urban and rural counties.
(D) The formula shall be: ((the county's
population multiplied by an adjustment factor) plus (the county's geographic
size multiplied by an adjustment factor) plus (the county's total emergency
health care runs multiplied by an adjustment factor) divided by 3) multiplied
by the total EMS allocation). The adjustment factors will be manipulated so
that the distribution approximates the required percentages to urban and rural
counties. Total emergency health care runs shall be the number of emergency
runs electronically transmitted to the department in a given calendar year by
EMS providers.
(2) TSA
allotment.
(A) A RAC's share of the TSA
allotment shall be based on its relative geographic size, population, and
trauma care provided as compared to all other TSAs.
(B) The formula shall be: ((the TSA's
percentage of the state's total population) plus (the TSA's percentage of the
state's total geographic size) plus (the TSA's percentage of the state's total
trauma care) divided by 3) multiplied by the total TSA allotment). Total trauma
care shall be the number of trauma patient records electronically transmitted
to the department in a given calendar year by EMS providers and
hospitals.
(3)
Uncompensated care allotment.
(A) The
uncompensated care allotment shall be based on a TSA's relative geographic
size, population, and a TSA's percentage of the state's total reported
uncompensated trauma care.
(B) The
formula shall be: ((the TSA's percentage of the state's total population) plus
(the TSA's percentage of the state's total geographic size) plus (the TSA's
percentage of the total reported cost of uncompensated trauma care by qualified
hospitals that year) divided by 3) multiplied by the total uncompensated care
allotment).
(C) For purposes of
subparagraphs (A)-(B) of this paragraph, the reporting period of a facility's
uncompensated trauma care shall apply to costs incurred during the preceding
calendar year.
(D) The department
may choose to distribute funds outlined in paragraph (3) of this subsection, to
eligible recipients, in conjunction with the distribution of funds outlined in
§
157.131(e)(2)
of this title concerning the hospital allocation of the designated trauma
facility and emergency medical services account.
(f) Loss of funding eligibility.
If the department finds that an EMS provider, RAC, or trauma facility has
violated the Health and Safety Code, §
773.122,
or fails to comply with this section, the department may withhold account
monies for a period of one to three years depending upon the seriousness of the
infraction.