Current through Register Vol. 24-06, March 15, 2024
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) "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.
(b) "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)
Designated trauma rehabilitation services:
(i) Levels I-III; and
(ii) Level 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;
(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 will
include:
(a) Participation grants to levels
I-V general and I-III pediatric, 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) Trauma care
grants, which will be awarded once a year to level I-III designated acute
trauma services to subsidize uncompensated trauma care costs. To be eligible
for the grants, trauma services must comply with Washington state's DOH trauma
registry requirements per WAC
246-976-420 through
246-976-430 including submission
of complete financial data and injury coding data. The grants will be
calculated by multiplying a hospital's bad debt and charity care ratio times
the sum of injury severity scores (ISS) for a specific period. The results for
all eligible trauma services are summed, and each trauma service will receive a
proportionate share of the available uncompensated trauma care grant allocation
based on their percentage of the overall total. The bad debt and charity care
ratio is calculated by summing a hospital's bad debt and charity care figures
divided by the hospital's total patient revenue for the same period. These
figures are from annual financial data reported to the department per chapters
246-453 and 246-454 WAC. Injury severity scores are extracted from trauma
registry data for cases that:
(i) Meet the
trauma registry inclusion criteria per WAC
246-976-420; and
(ii) Are admitted with an ISS of thirteen or
greater for adults, nine or greater for pediatric patients less than fifteen
years of age, or trauma patients received in transfer regardless of the
ISS.
(c) Trauma care
grants, which will be awarded once a year to designated acute trauma services
levels IV, V, and/or critical access hospitals (CAH) to subsidize their costs
for providing care to the trauma patients, and for stabilizing and transferring
major trauma patients. The individual grant amounts are based on designation
level.
(5) The
department may issue grants to DOH-certified medical program directors (MPD)
for their role in the EMS/TCS as described in WAC
246-976-920.
(6) The department's distribution method for
designated trauma rehabilitation services, levels I-III and I-pediatric will
include at least:
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:
(a) Level of
designation;
(b) Volume of
service;
(c) Other factors that
relate to trauma care.
Statutory Authority: Chapter 70.168 RCW. 04-12-126,
§ 246-976-935, filed 6/2/04, effective 7/3/04. Statutory Authority:
RCW
70.168.040. 02-04-045, § 246-976-935,
filed 1/29/02, effective 3/1/02. Statutory Authority: Chapter 70.168 RCW.
98-05-035, § 246-976-935, filed 2/10/98, effective
3/13/98.