Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 157 - EMERGENCY MEDICAL CARE › Subchapter G - EMERGENCY MEDICAL SERVICES TRAUMA SYSTEMS › Section 157.130 - Emergency Medical Services and Trauma Care System Account and Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund

Current through Reg. 49, No. 28; July 12, 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.