Trauma Disproportionate Share Payments
[41 Pa.B. 3309]
[Saturday, June 25, 2011]
The Department of Public Welfare (Department) is announcing its intent to amend the qualifying criteria and payment methodology and increase funding for an additional class of disproportionate share hospital payments to hospitals that qualify as trauma centers for the purpose of improving access to readily available and coordinated trauma care for the citizens of this Commonwealth. The Department is increasing funding for these payments as a result of additional funding allocations in the Commonwealth's 2010-2011 budget. The qualifying criteria and payment methodology are being amended as a result of requirements established in the Pennsylvania Trauma Systems Stabilization Act (62 P. S. §§ 801-H—808-H).
Level I and Level II Trauma Centers
A hospital located in this Commonwealth shall qualify as a trauma center (qualified trauma center) if it is accredited by the Pennsylvania Trauma Systems Foundation (Foundation) as a Level I or Level II trauma center.
An out-of-State hospital will qualify as a trauma center (out-of-State qualified trauma center) if the hospital operates a trauma center that annually discharges more than 30 patients, who qualify as trauma patients under the Pennsylvania Trauma Outcome Study (PTOS) for 2 of the preceding 4 years or is West Virginia University Hospital and meets each of the following requirements:
(1) Is accredited as a Level I or Level II trauma center by the Foundation; or has obtained verification from the American College of Surgeons as a Level I or Level II trauma center; and is formally designated as a Level I or Level II trauma center by its home state.
(2) Pays to the Foundation the annual participation fee the out-of-State hospital would be charged were it accredited by the Foundation as a Level I or Level II trauma center.
Out-of-State qualified trauma centers shall submit to the Foundation on an annual basis the following:
(1) A copy of the clinical patient data the hospital submits to the National Trauma Database regarding residents in this Commonwealth who receive trauma services from the hospital.
(2) The total and Commonwealth resident-specific number of PTOS trauma visits and patient days for individuals who are Medical Assistance (MA) recipients and those who are uninsured. The definition of what constitutes a PTOS trauma case shall be the same for both Commonwealth and out-of-State hospitals.
There will be no changes to the payment methodology for Level I and Level II trauma centers, including out-of-State hospitals.
Level III Trauma Centers
The Foundation will accredit Level III trauma centers using standards based on the American College of Surgeons guidelines for Level III trauma centers. In addition to these standards, a hospital shall meet all of the following criteria to qualify for Level III accreditation:
(1) Provide comprehensive emergency services.
(2) Have, on an annual basis, at least 4,000 inpatient admissions from its emergency department.
(3) For trauma centers accredited or seeking accreditation prior to October 23, 2010:
(a) Be located in a county without an accredited Level I or Level II trauma center.
(b) Not be located within 25 miles travel distance from a Level I or Level II trauma center.
(4) For trauma centers accredited or seeking accreditation on or after October 23, 2010:
(a) Be located in a county of the third to eighth class.
(b) Not be located within 25 miles travel distance from a Level I, Level II or Level III trauma center.
The Department will allocate 10% of the total available funds to hospitals accredited or seeking accreditation as Level III trauma centers for up to 4 years, with documented evidence of progression towards accreditation and achievement of benchmarks as verified and established by the Foundation in collaboration with the Department (qualified Level III trauma centers).
(1) Fifty percent of this amount available for Level III trauma centers will be distributed equally among qualified Level III trauma centers.
(2) Fifty percent of the total amount available for Level III trauma centers will be distributed on the basis of each qualified Level III trauma center's percentage of MA and uninsured PTOS trauma cases and patient days compared to the Commonwealth Statewide total number of MA and uninsured PTOS trauma cases and patient days for qualified Level III trauma centers.
For these payments, the Department will calculate payment to each qualified Level III trauma center using PTOS data provided by the Foundation. For purposes of calculating the hospital specific portion of the payment, the Department shall count all MA days, uninsured PTOS trauma cases and patient days, irrespective of the home state of the patient. Payment to each qualified Level III trauma center may not be greater than 50% of the average Statewide annual payment to a Level II trauma center.
The Fiscal Year 2010-2011 fiscal impact of the trauma payments is $25.523 million ($11.322 million in State funds).
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-696. (1) General Fund; (2) Implementing Year 2010-11 is $11,322,000; (3) 1st Succeeding Year 2011-12 is $0; 2nd Succeeding Year 2012-13 is $0; 3rd Succeeding Year 2013-14 is $0; 4th Succeeding Year 2014-15 is $0; 5th Succeeding Year 2015-16 is $0; (4) 2007-08 Program—$12,500,000; 2008-09 Program—$11,597,000; 2009-10 Program—$10,387,000; (7) Trauma Centers; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 11-1067. Filed for public inspection June 24, 2011, 9:00 a.m.]
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