This notice is to alert the public that the Office of Trauma is proposing revisions to Rule 64J-2.019, F.A.C., to implement revisions to this rule pursuant to requirement in subsections 318.18 and 395.4036, F.S. enacted in Chapter 2009-138, Laws of ...

DEPARTMENT OF HEALTH
Division of Emergency Medical Operations

RULE NO: RULE TITLE
64J-2.019: Funding for Verified Trauma Centers
PURPOSE AND EFFECT: This notice is to alert the public that the Office of Trauma is proposing revisions to Rule 64J-2.019, F.A.C., to implement revisions to this rule pursuant to requirement in subsections 318.18 and 395.4036, F.S. enacted in Chapter 2009-138, Laws of Florida (Enrolled HB 481).
SUMMARY: The proposed rule revisions include the following:
Adds another trauma center funding distribution methodology; adds a definition for “public hospital;” revises the definition of “attestation;” adds another attestation requirement, and statutory references to Section 318.18 to implement the 2009 statutory revisions under Section 395.4036, F.S. for the funds collected under Section 318.18(5)(c) and (19), F.S. (Chapter 2009-138, Laws of Florida). Deletes a portion of the definition of “Severe Injury Patient” to remove language regarding ICISS Ps<.90, which became obsolete after December 31, 2007. Technical amendment to correct the section reference of Section 395.4036, F.S., to correct an error in the section number; and technical amendment to correct the date of the Florida Trauma Registry Manual from December 2005 to February 2008 and to correct page number reference.
Technical amendment to add the word “verified” clarify the definition of “certified trauma center,” “verified trauma center” and “trauma center” to mean a Level I, Level II, or Pediatric Verified Trauma Center.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 395.4036 FS.
LAW IMPLEMENTED: 395.4036 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 2 days before the workshop/meeting by contacting: Priscilla Davidson at [phone], ext: 2749. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Susan McDevitt, Office of Trauma Director, Department of Health, 4052 Bald Cypress Way, Bin #C-18, Tallahassee, FL 32399-1738; [phone], ext: 2760; email: [e-mail]; fax: [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

64J-2.019 Funding for Verified Trauma Centers.

(1) For purposes of Sections 318.14, 318.18 and 395.4036, F.S., and this rule, in addition to those terms defined in the Florida Trauma Registry Manual, February 2008 December 2005, (see Rule 64J-2.006, F.A.C.) and elsewhere in these rules, the following definitions also apply:

(a) “Attestation” – means a letter on hospital letterhead, signed under oath consistent with Section 92.50, F.S., by the person with direct or delegated authority to make such a statement as required in accordance with this rule., stating that the proceeds received by the hospital under Section 395.4036, F.S., were used in compliance with law.a statement, stating that: the proceeds received by the hospital under Section 395.4036, F.S., were used in compliance with law.

(b) “Certified trauma center,” “verified trauma center” and “trauma center” – all mean a Level I, Level II or Pediatric Verified Trauma Center.

(c) “Caseload volume,” “trauma caseload volume, “and “volume of trauma cases” – all mean the number of verified trauma patients served by a trauma center during a calendar year, after 2004, on whom data timely supplied by the trauma center to the trauma registry satisfies the Florida Trauma Registry Manual, February 2008 December 2005 reporting requirements for determining trauma caseload volume (see page 65 of the manual).

(d) “International Classification Injury Severity Score” (ICISS) means a mathematical system of risk stratification based on anatomic diagnosis of trauma patients as initially defined and validated in the following reference: “Osler T, Rutledge R, Deis J, Bedrick E., ICISS: an international classification of disease-9 based injury severity score, Journal of Trauma. 1996 Sep:41(3):380-6; discussion 386-8.”

(e) “Public hospital” – means a hospital licensed under Chapter 395, Part I, F.S., which is owned by a state or local government, or local healthcare tax district.

(f)(e) “Severe Injury Patient” – Through December 31, 2007, means a verified trauma patient with a computed ICISS Ps<.90 and, after December 31, 2007, means a verified trauma patient with computed ICISS Ps<.85.

(g)(f) “Verified Trauma Patient” means a patient treated at a state certified trauma center with at least one ICD-9-CM discharge diagnosis between 800 and 959.9 with a Survival Risk Ratio (SRR)<1 whose data is used by the trauma registry to determine caseload volume. SRRs for each diagnosis code will be determined from analysis of data in the trauma registry by the Department consistent with ICISS and shall be published by the Department.

(h)(g) “Year” – means the most recent complete calendar year for which caseload volume is available from the trauma registry.

(2) Funds collected under Sections 318.14(5), 318.18(5) (c) and (19) and 318.18(15), F.S., and deposited into the department’s administrative trust fund shall be distributed quarterly to the certified trauma centers.

(a) All distribution shall be consistent with subsection (2) or upon resolution of all relevant administrative and judicial challenges, whichever is later.

(b) Funds collected under Section 318.14(5), F.S., and deposited into the department’s administrative trust fund shall be distributed to the trauma center as follows: [(.5 x funds)/Current total number of trauma centers)] + [(.5 x funds) x (Caseload volume for the trauma center for the year/The sum of caseload volume for all trauma centers during the year)].

(c) Funds collected under Section 318.18(15), F.S., and deposited into the department’s administrative trust fund under Section 395.40364095(1), F.S., shall be distributed as follows:

1. To each trauma center in a region receiving a local funding contribution as of December 31 of the previous year: (.2 x funds) x (Caseload volume for the trauma center for the year/The sum of caseload volume for the year for all trauma centers receiving funding under subparagraph (2)(c)1. of this rule).

2. To each trauma center: (.4 x funds) x (Caseload volume of the trauma center during the year/The sum of caseload volume for all trauma centers during the year).

3. To each trauma center: (.4 x funds) x (The total number of severe injury patients served by the trauma center for the year/The total number of all severe injury patients served by all trauma centers for the year).

(d) Funds collected under Section 318.18(5)(c) and (19), F.S., and deposited into the department’s administrative trust fund shall be distributed as follows.

1. To each Level II trauma center operated by a public hospital that provides an attestation certifying that the hospital is governed by an elected board of directors as of December 31, 2008: (.30 x funds).

2. To each trauma center: (.35 x funds) x (Caseload volume of the trauma center during the year/The sum of caseload volume for all trauma centers during the year).

3. To each trauma center: (.35 x funds) x (The total number of severe injury patients served by the trauma center for the year/The total number of all severe injury patients served by all trauma centers for the year).

(3) Hospitals that are not subject to audit pursuant to Section 215.97, F.S. and operate a verified trauma center that receives proceeds under Section 395.4036, F.S., must annually submit to the department an attestation stating the proceeds received by the hospital were used in compliance with Section 395.4036(3)(a), F.S.

Rulemaking Specific Authority 395.4036 FS. Law Implemented 395.4036 FS. History–New 4-25-06, Amended 1-9-07, Formerly 64E-2.040, Amended_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Susan McDevitt, Director, Office of Trauma
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Ana Viamonti-Ros, M.D., M.P.H., State Surgeon General
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 12, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 2, 2009