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 157.131 - Designated Trauma Facility and Emergency Medical Services Account

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 met the facility's trauma team activation criteria and/or were entered into
				  the facility's Trauma Registry and 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 and
				  959.9, including 940-949 (burns), excluding 905-909 (late effects of injuries),
				  910-924 (blisters, contusions, abrasions, and insect bites), 930-939 (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 (a)(5) of this section 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) Active pursuit of department designation
				  as a trauma facility--means that an undesignated licensed facility, applying
				  for designation from the department as a trauma facility after September 1,
				  2005, must submit to the department:
(A) a
				  statement of intent to seek designation;
(B) a timely and sufficient application to
				  the department's trauma facility designation program or appropriate agency for
				  trauma verification;
(C) evidence
				  of participation in Trauma Services Area (TSA) Regional Advisory Council (RAC)
				  initiatives;
(D) evidence of a
				  hospital trauma performance improvement committee; and
(E) data to the department's EMS/Trauma
				  Registry.
(11)
				  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 (13) of this subsection and derived in accordance with
				  generally accepted accounting principles.
(12) 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.
(13) 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.