NOTICES
DEPARTMENT OF
HUMAN SERVICES
Disproportionate Share Payments for Trauma Services
[50 Pa.B. 2141]
[Saturday, April 18, 2020]The Department of Human Services (Department) is announcing its intent to allocate funds for Fiscal Year (FY) 2019-2020 disproportionate share hospital (DSH) payments to Medical Assistance (MA) enrolled acute care general hospitals that qualify as a trauma center for the purpose of improving access to readily available and coordinated trauma care for the citizens of this Commonwealth. The Department is amending the qualifying criteria and payment methodology due to the act of July 2, 2019 (P.L. 359, No. 54).
All payment limitations are still applicable, including those limitations that the Commonwealth may not exceed its aggregate annual DSH allotment, and that no hospital may receive DSH payments in excess of its hospital-specific limit.
Qualifying Criteria
Unless otherwise stated, the source of the information for this payment is the most recent available Pennsylvania Trauma Outcome Study (PTOS) prepared by the Pennsylvania Trauma Systems Foundation (Foundation).
A hospital shall qualify as a trauma center if it meets one of the following criteria:
1) Is located in this Commonwealth and is accredited by the Foundation as a Level I, Level II or Level III trauma center.
2) Is located in this Commonwealth and has submitted an application to the Foundation seeking Level III accreditation and has documented evidence or progression towards accreditation and achievement of benchmarks as verified and established by the Foundation in collaboration with the Department for up to 4 years. In addition to the established standards, a hospital applying for Level III certification qualifies as a Level III trauma center if it meets all the following criteria:
a. Provides comprehensive emergency services.
b. Has at least 4,000 inpatient admissions from its emergency department on an annual basis.
c. Is located in a county of the third, fourth, fifth, sixth, seventh or eighth class.
d. Is located more than 25 miles travel distance from a Level I, Level II or Level III trauma center unless the hospital can demonstrate that other trauma centers in the catchment area have a volume of excess cases which is twice the amount needed for reaccreditation for the 3 preceding years.
3) Is located in a rural county of this Commonwealth, as defined by the Center for Rural Pennsylvania, and is accredited by the Foundation as a Level IV trauma center;
4) Is an ''out-of-state qualified trauma center'' for purposes of eligibility for this additional class of DSH payment. The term out-of-state qualified trauma center means West Virginia University Hospital, or an out-of-state trauma center that meets each of the following requirements:
a. 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.
b. 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.
c. Annually discharges more than 30 patients, who qualify as trauma patients under the PTOS for 2 of the preceding 4 years.
Out-of-state qualified trauma centers shall submit to the Foundation on an annual basis both:
(1) a copy of the clinical patient data the hospital submits to the National Trauma Database regarding residents of this Commonwealth who receive trauma services from the hospital; and
(2) the total and Pennsylvania resident-specific number of PTOS trauma visits and patient days for individuals who are MA beneficiaries 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.
Payment Methodology
For purposes of calculating the hospital-specific portion of the DSH payment, the Department shall count all MA days, uninsured PTOS trauma visits and patient days, irrespective of the home state of the patient. The Department may use any funds available for this additional class of DSH payments to make payments to eligible out-of-state trauma centers. The Department will make DSH payments under this additional class of DSH payments to qualifying trauma centers using the following payment methodology:
1) 90% of the total available funds will be allocated to hospitals with qualified Level I and Level II trauma centers, including out-of-state qualified trauma centers as follows:
a. 50% of the amount available for Level I and Level II trauma centers will be distributed equally among Level I and Level II trauma centers.
b. 50% of the total amount available for Level I and level II trauma centers will be distributed on the basis of each qualified trauma center's percentage of MA and uninsured PTOS trauma visits and patient days compared to Statewide total number of MA and uninsured PTOS trauma visits and patient days for Level I and Level II trauma centers.
2) 10% of the total available funds will be allocated to hospitals with qualified Level III trauma centers and qualified trauma centers seeking accreditation as Level III as follows:
a. 50% of the amount available for Level III trauma centers will be distributed equally among Level III trauma centers.
b. 50% of the total amount available for Level III trauma centers will be distributed on the basis of each trauma center's percentage of MA and uninsured PTOS trauma visits and patient days compared to the Statewide total number of MA and uninsured PTOS trauma visits and patient days for Level III trauma centers.
c. Payment to each qualifying Level III trauma center may not be greater than 50% of the average Statewide annual payment to a Level I or Level II trauma center.
3) Funds not distributed to Level I, II or III qualified trauma centers will be paid to hospitals with qualified Level IV trauma centers as follows:
a. 50% of the amount available for Level IV trauma centers will be distributed equally among Level IV trauma centers.
b. 50% of the total amount available for Level IV trauma centers will be distributed on the basis of each trauma center's percentage of MA and uninsured PTOS trauma visits and patient days compared to the Statewide total number of MA and uninsured PTOS trauma visits and patient days for Level IV trauma centers.
c. Payment to each qualifying Level IV trauma center may not be greater than 50% of the average Statewide annual payment to a Level I or Level II trauma center.
4) Funds unspent after distribution to Level IV qualified trauma centers will be paid to hospitals with qualified Level l and Level II trauma centers as follows:
a. 50% of unspent funds shall be distributed equally among qualified Level l and Level ll trauma centers.
b. 50% of unspent funds shall be distributed on the basis of each qualified Level l and Level ll trauma center's percentage of MA and uninsured PTOS trauma visits and patient days compared to Statewide total number of MA and uninsured PTOS trauma visits and patient days for Level l and Level ll trauma centers.
Fiscal Impact
The FY 2019-2020 impact, as a result of the funding allocation for these payments, is $18.128 million ($8.656 million in State general funds and $9.472 million in Federal funds) upon approval by the Centers for Medicare & Medicaid Services.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. The Department will review and consider comments received within 30 days in determining the final payment methodology for these payments.
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).
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1388. (1) General Fund; (2) Implementing Year 2019-20 is $8,656,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $0; (4) 2018-19 Program—$8,656,000; 2017-18 Program—$8,656,000; 2016-17 Program—$8,656,000; (7) Trauma Centers; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 20-548. Filed for public inspection April 17, 2020, 9:00 a.m.]
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