Oklahoma Administrative Code › Title 310 - Oklahoma State Department of Health › Chapter 669 - Trauma Care Assistance Revolving Fund › Subchapter 1 - General Provisions › Section 310:669-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms, when used in this Chapter,
				  shall have the following meaning unless the context clearly indicates
				  otherwise:
"Ambulance service"
means an entity licensed in
				  accordance with 63 O.S. Supp. 2000, 1-2501, et seq.
"Bad debt"
means the actual amount of
				  uncollectible charges written off by a distribution entity, and arising from
				  providing trauma care at an inpatient or outpatient facility, or transportation
				  service, and that is calculated as the net of bad debt recoveries applied
				  against bad debt expenses
.
"Charity care"
means trauma care at an inpatient
				  or outpatient facility, or transportation services for which a distribution
				  entity never expected to be reimbursed based on the distribution entity's
				  determination of the patient's ability to pay based on the distribution
				  entity's established standards.
"Commissioner"
means the State Commissioner of
				  Health.
"Cost report"
means the latest annual reporting
				  statement filed by a facility with its fiscal intermediary in compliance with
				  requirements enforced by the Centers for Medicare and Medicaid Services.
"Cost to charge ratio"
means the factor(s)
				  calculated annually using information reported as part of a facility's cost
				  report.
"Department"
means the State Department of
				  Health.
"Distribution entity"
means an ambulance service
				  or trauma facility that provided uncompensated care and reported the care
				  respectively to the pre-hospital emergency medical service database in
				  accordance with OAC 310:631-3-160(b), and the state trauma registry in
				  accordance with OAC
				  310:669-3-1.
				  This will also include physicians licensed in Oklahoma during the time the
				  trauma care is provided.
"Fund"
means the Trauma Care Assistance
				  Revolving Fund.
"Gross revenues"
means the charges for inpatient
				  and outpatient services uniformly applied at the regular rates established to
				  all patients by the distribution entity prior to the application of any
				  adjustments, allowances, discounts, or revenue deductions.
"Medicare Allowed Reimbursement"
means the
				  allowed reimbursement established by the Centers for Medicare and Medicaid
				  Services for the geographic location where inpatient or outpatient care is
				  provided by a physician or transportation services are provided by a
				  freestanding ambulance service.
"Run report"
means the standard report form
				  developed by the Commissioner to facilitate the collection of a standardized
				  data set related to the provision of emergency medical and trauma care in
				  accordance with 63 O.S. Section
				  1-2511.
"Tier A Physician"
means a physician
				  credentialed by the medical staff to provide emergency care to trauma patients
				  in the specialties of emergency medicine, neurosurgery, general surgery,
				  maxillo-facial surgery, orthopedic surgery, surgery specialties,
				  anesthesiology, and trauma intensivists.
"Tier B Physician"
means a physician
				  credentialed by medical staff to provide care to trauma patients in a specialty
				  area not defined in Tier A.
"Trauma"
means bodily injury that produces
				  injuries severe enough to cause disability or death.
"Trauma care"
means treatment or transportation
				  for treatment of a bodily injury that produces injures severe enough to cause
				  disability or death.
"Trauma facility"
means a hospital classified by
				  the Department as providing a Level I, II, III, or IV Trauma and Emergency
				  Operative Service.
"Trauma registry"
means
the statewide
				  emergency medical services and trauma analysis system developed pursuant to the
				  provisions of Section 1-2511
of Title 63 of the Oklahoma Statutes.
				  [63:330.97]
"Trauma team"
means a specific team identified
				  in policy and required to respond to the hospital to care for the traumatically
				  injured within a specified period of time, monitored by a quality assurance
				  process.
"Uncompensated care"
means care provided for
				  which expected payment was not received from the patient or insurer or any
				  other identified payor source. Uncompensated care is the sum of a distribution
				  entity's bad debt and charity 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 21 Ok Reg 2440, eff 7-11-05; Amended at 24 Ok Reg 2025, eff
				  6-25-07