Title 15: Mississippi Department of Health

Part 3: Bureau of Acute Care Systems

Subpart 1: Trauma System of Care

Chapter 1 Mississippi Trauma System of Care

Subchapter 1 General

Rule 1.1.1. Legal Authority: The Mississippi State Department of Health (the Department) is assigned the responsibility for creating, implementing and managing the statewide trauma system. The Department shall be designated as the lead agency for trauma system development. The Department shall develop and administer trauma regulations that include, but are not limited to, the Mississippi Trauma System of Care Plan, trauma system standards, trauma center designations, field triage, inter-facility trauma transfer, pediatric trauma care, burn care, trauma data collection, trauma system evaluation and management of state trauma system funding. The Department shall promulgate regulations specifying the methods and procedures by which Mississippi-licensed acute care facilities shall participate in the statewide trauma system. Those regulations shall include mechanisms for determining the appropriate level of participation for each facility or class of facilities. The Department shall also adopt a schedule of fees to be assessed for facilities that choose not to participate in the statewide trauma system, or which participate at a level lower than the level at which they are capable of participating. The Department shall take the necessary steps to develop, adopt and implement the Mississippi Trauma System of Care Plan and all associated trauma system regulations necessary to implement the Mississippi Trauma System. The Department shall cause the implementation of professional and lay trauma education programs. These trauma educational programs shall include clinical trauma education and injury prevention. As it is recognized that rehabilitation services are essential for traumatized individuals to be returned to active, productive lives, the Department shall coordinate the development of an inclusive trauma system, which shall incorporate licensed acute care facilities designated based on resources and staffing, with the Mississippi Department of Rehabilitation Services and all appropriate rehabilitation systems.

Source: Miss. Code Ann. § 41-59-5

Rule 1.1.2. Mississippi Trauma Advisory Committee: The Mississippi Trauma Advisory

Committee (MTAC) is created as a committee of the Emergency Medical Services Advisory Council. The membership of the MTAC is comprised of the members of the Emergency Medical Services Advisory Council (EMSAC); the members of which are appointed by the Governor. The Chairman of EMSAC shall appoint EMSAC members to the MTAC. This committee shall act as the advisory body for trauma system development, and provide technical support to the Department in all areas of trauma system design, trauma standards, data collection and evaluation, continuous quality improvement, trauma system funding, and evaluation of the trauma system and trauma care programs.

Source: Miss. Code Ann. § 41-59-7

Rule 1.1.3. Mississippi Trauma Advisory Committee Meetings: The Mississippi Trauma

Advisory Committee (MTAC) shall meet at least quarterly and report to the State Board of Health at its regularly scheduled meetings on the performance of Trauma System. For attendance at such meetings, the members of the MTAC shall be reimbursed for their actual and necessary expenses including food, lodging and mileage as authorized by law, and they shall be paid per diem compensation.

Source: Miss. Code Ann. § 41-59-7; Miss. Code Ann. § 25-3-41; and Miss. Code Ann. § 25-3-69.

Rule 1.1.4. Definitions: For the purposes of the Mississippi Trauma System, the following abbreviations, acronyms, and terms shall be defined as listed.

1. ACEP – American College of Emergency Physicians.

2. ACLS – Advanced Cardiac Life Support.

3. ACSCOT – American College of Surgeons Committee on Trauma.

4. AIS – Abbreviated Injury Scale.

5. ALS – Advanced life support, including techniques of resuscitation, such as, intravenous access, and cardiac monitoring.

6. APLS – Advanced Pediatric Life Support.

7. ATCN – Advanced Trauma Care for Nurses. A course designed for the registered nurse interested in increasing his/her knowledge in the management of multiple trauma patient.

8. ATLS – Advanced Trauma Life Support.

9. Alpha Patient – A trauma patient meeting the criteria for an Alpha (major trauma or seriously injured) Alert/Activation (refer to Trauma Activation Criteria document maintained on the Department’s website).

10. BACS – Bureau of Acute Care Systems, Mississippi State Department of Health.

11. BEMS – Bureau of Emergency Medical Services, Mississippi State Department of Health.

12. BLS – Basic life support techniques of resuscitation, including simple airway maneuvers, administration of oxygen, and intravenous access.

13. Board Certified – Physicians and oral/maxillofacial surgeons certified by appropriate specialty boards recognized by the American Board of Medical Specialties and the Advisory Board of Osteopathic Specialties and the American Dental Association.

14. Burn Fund – Mississippi Burn Care Fund established under Miss. Code Ann. § 7- 9-

70.

15. BTLS – Basic Trauma Life Support.

16. Bravo Patient – A trauma patient not meeting the criteria for an Alpha Alert/

Activation, however, has received injuries requiring immediate attention (refer to Trauma Activation Criteria document maintained on the Department’s website).

17. CAP – Corrective Action Plan.

18. CCRN – Critical Care Registered Nurse.

19. CEN – Certified Emergency Nurse.

20. Catchment Area – Geographic area served by a designated trauma center for the purpose of trauma system planning, development and operations.

21. Department – also, “the Department” refers to the Mississippi State Department of Health

22. Designation – Formal recognition of hospitals by the Department as providers of specialized trauma services to meet the needs of the severely injured patient.

23. Diversion (trauma center) – Circumstances where a trauma center cannot accept the inter-facility transfer of injured trauma patients due to service or facility limitations. NOTE: This does not include pre-hospital/EMS.

24. E&D Chart – Essential and Desirables Chart for each trauma center designation level.

25. Emergency Department (or Emergency Room) – The area of an acute care hospital where the facility customarily receives patients in need of emergency medical evaluation and/or care.

26. EMS – Emergency Medical Services.

27. EMSAC – Emergency Medical Services Advisory Council.

28. ENA – Emergency Nurses Association.

29. Field Triage – Classification of patients according to medical need at the scene of an injury or onset of an illness.

30. GCS – Glasgow Coma Scale.

31. Immediately (or immediately available) – (a) unencumbered by conflicting duties or responsibilities; (b) responding without delay when notified; and (c) being within the specified resuscitation area of the trauma center when the patient is delivered or when notified by EMS that a patient is enroute, whichever is shorter. Specific times for each physician specialty are in the applicable trauma center level chapter.

32. Inclusive Trauma System – a trauma system incorporating every licensed acute care facility with an emergency department in order to provide a continuum of services for all injured persons who require care; in such a system, the injured patient's needs are matched to appropriate hospital resources.

33. Injury – (a) the result of an act that damages, harms, or hurts; (b) unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical or chemical energy or from the absence of essentials such as heat or oxygen.

34. Injury Prevention – efforts to forestall or prevent incidents that might result in injuries.

35. ISS – Injury Severity Score.

36. Level I Trauma Centers – Hospitals that have met the requirements for Level I as stated in Chapter 2 and are designated by the Department.

37. Level II Trauma Centers – Hospitals that have met the requirements for Level II as stated in Chapter 3 and are designated by the Department.

38. Level III Trauma Centers – Hospitals that have met the requirements for Level III as stated in Chapter 4 and are designated by the Department.

39. Level IV Trauma Centers – Hospitals that have met the requirements for Level IV as stated in Chapter 5 and are designated by the Department.

40. Medical Control – Physician direction over pre-hospital activities to ensure efficient trauma triage, transportation and care, as well as ongoing quality management.

41. Mid-level Providers/Practitioners – Physician Assistants (PA) and/or Nurse Practitioners (NP)

42. Mississippi Trauma System of Care Plan – The plan developed by the Department which sets out a comprehensive system of prevention, management and rehabilitation of major traumatic injuries. The plan is published on a three-year cycle.

43. Multidisciplinary Trauma Committee – Hospital committee composed of the trauma service Director, other physician members and other members appointed by the Trauma Medical Director that reviews trauma deaths in a hospital.

44. MTAC – Mississippi Trauma Advisory Committee.

45. Non-Designated Hospital – A licensed acute care hospital that has applied for designation as a trauma center but has not been designated by the Department.

46. Non-Participating Hospital – A licensed acute care hospital that has informed the

Department that they do not desire to participate in the Trauma System, or a hospital that does not have a current designation or application for designation on file with the Department.

47. On-Call – Available to respond to the trauma center in order to provide a defined service.

48. PALS – Pediatric Advanced Life Support.

49. Pediatric Trauma Center – Hospitals that have met the requirements for Primary, Secondary, or Tertiary Pediatric Trauma Center designation as stated in Chapter 6 and has been designated by the Department.

50. PHTLS – Pre-Hospital Trauma Life Support.

51. Promptly (or promptly available) – Arrival of on-call physician specialists within the trauma receiving resuscitation area, emergency department, operating room, or other specified area of the trauma center within a maximum of 60 minutes from the time of notification to respond.

52. Performance Improvement (PI or Quality Improvement) – A method of evaluating and improving processes of patient care which emphasizes a multi-disciplinary approach to problem solving and focuses not on individuals but on systems of patient care which might cause variations in patient outcome.

53. Rehabilitation – Services that seek to return a trauma patient to the fullest physical, psychological, social, vocational, and educational level of functioning of which he or she is capable, consistent with physiological or anatomical impairments and environmental limitations.

54. Research – Clinical or laboratory studies designed to produce new knowledge applicable to the care of injured patients.

55. Residency Program – A residency program of the trauma center or a residency program formally affiliated with the trauma center where senior residents can participate in educational rotations.

56. RTTC – Rural Trauma Team Course.

57. RTS – Revised Trauma Score, a pre-hospital/Trauma Center scoring system in which numerical values are assigned to differing levels of Glasgow Coma Scale, systolic blood pressure, and respiratory rate.

58. Senior Resident (or "senior level resident") – A physician licensed in the State of

Mississippi who has completed at least two years of the residency under consideration and has the capability of initiating treatment, when the clinical situation demands, and who is in training as a member of the residency program, as defined in regulation, at a designated trauma center. Residents in general surgery shall have completed three clinical years of general surgery residency in order to be considered a senior resident.

59. Service Area (or "catchment area") – Geographic area defined by the local EMS agency as the area served by a designated trauma center.

60. SHO – State Health Officer.

61. TCTF – Trauma Care Trust Fund.

62. TMD – Trauma Medical Director; a physician designated by the trauma center to coordinate trauma care.

63. TNCC – Trauma Nursing Core Course.

64. TPM – Trauma Program Manager; a designated RN with responsibility for coordination of all activities on the trauma service and works in collaboration with the TMD.

65. TSMD – state Trauma System Medical Director.

66. Trauma Registry – a database program managed by the Department that hospitals use to track treatment of trauma victims.

67. Trauma Team – A group of health care professionals organized to provide care to the trauma patient in a coordinated and timely fashion. The composition of a trauma team is delineated by hospital policy.

68. Triage – the process of sorting injured patients on the basis of the actual or perceived degree of injury and assigning them to the most effective and efficient trauma care resources, in order to ensure optimal care and the best chance of survival.

Subchapter 2 Designation of Trauma/Burn Centers

Rule 1.2.1. Application for Initial Trauma/Burn Center designation.

a. To receive designation as a trauma center, or as a burn center, or as a tertiary pediatric trauma center, an applicant hospital shall submit an application to the Department. Within 60 days of receipt of the application, the Department shall provide written notification to the applicant hospital that the application has been received by the Department; whether the Department accepts or rejects the application; if accepted, the date scheduled for an education visit; if rejected, the reasons for rejection and a deadline for submission of the corrected application to the Department.

Rule 1.2.2. Trauma Center Education Visit:

1. Designated Level I, II, III Trauma Centers; Burn Centers; or Tertiary Pediatric

Trauma Centers may request an education visit. This visit is used to assist the applicant hospital in preparation for the trauma center survey. The results of the visit will be held in confidence by the Department. The Department will work with and provide assistance to the applicant hospital to correct any deficiencies noted during the education visit. Education visits may be conducted on-site or by telephone/video conference; the applicant hospital shall request the preferred type of visit. The composition of the education team shall be determined by the Department.

2. If an applicant hospital requests a trauma center survey without having first received an education visit and the hospital fails to meet designation criteria, the survey shall be deemed an education visit. Any subsequent survey for designation as a trauma center shall be at the applicant hospital’s expense.

Rule 1.2.3. Hospital Surveys

1. The Department shall provide for the survey of the applicant hospital, provided that its application has been formally approved by the Department, on the date scheduled and indicated in the Department's acceptance letter to the applicant hospital, unless the Department provides written notification with justification of change to the applicant hospital no later than 14 days prior to the survey date; or the applicant hospital provides written request with justification for a change in the survey date to the Department no later than 30 days prior to the survey date.

2. Results of trauma center surveys will be provided by the Department in writing to the applicant hospital. Details related to the hospital's survey will be considered confidential and will not be released.

3. Surveys of Mississippi licensed hospitals and those that currently participate in the Trauma System may be conducted by national accrediting organizations, i.e., American College of Surgeons or American Burn Association. The Department must be present and receive the complete report from the accrediting organization, including any/all Corrective Action Plans (CAP). The Department shall review the report for compliance with the Mississippi Trauma System Rules and Regulations and shall make a recommendation to the State Health Officer for designation.

Rule 1.2.4. Level I, II, and III Trauma Center, Burn Center, and Tertiary Pediatric Trauma

Center On-site Surveys

1. The Department shall provide multidisciplinary teams for all on-site surveys.

2. Trauma Center survey teams shall consist of disciplines as follows:

• Level I and II Trauma Centers: Teams shall consist of the following representative disciplines: trauma/general surgeon, emergency medicine physician, and trauma nursing. The Department may add additional team members as necessary. All members of teams for Level I and II Trauma Center inspections shall reside and practice outside the State of Mississippi.

• Level III Trauma Centers: As a minimum, teams shall consist of the following representative disciplines: trauma/general surgeon and trauma nursing. Team members may reside in Mississippi; however, they may not practice in any hospital or reside within 60 miles of the applicant hospital. The Department may add team members as necessary.

• Burn Centers: Teams shall consist of the following representative disciplines:

surgeon with experience/credentials in burn care and trauma/burn nursing.

Team members may reside in or outside of Mississippi; however, they may not practice in any hospital or reside within 60 miles of the applicant hospital.

The Department may add team members as necessary.

• Tertiary Pediatric Trauma Centers: Teams shall consist of the following representative disciplines: trauma/general surgeon with pediatric experience/credentials, emergency medicine physician with pediatric experience, and trauma nursing with pediatric experience. The Department may add team members as necessary. All team members shall reside outside of the State of Mississippi.

Rule 1.2.5. Categories of Trauma Center Designations

1. Complete Designation: The hospital has completed all requirements for designation at the application level.

2. Complete Designation with Conditions: The hospital has completed all requirements for Complete Designation at the application level with the exception of minor (no patient or operational impact) condition(s). This designation category may be used for initial designations or an interim change in status from Complete Designation due to a temporary loss of a capacity or capability.

• The Department, upon receipt, shall either approve or disapprove the plan within thirty (30) days. The Department may require a "Focused Survey" with an inspection team to review the hospital’s CAP for complete implementation. If the Focused Survey team deems the CAP fully implemented, the hospital will receive Complete Designation.

Rule 1.2.6. Term of Trauma Center Designations:

1. The Department shall designate trauma centers for a period not to exceed three (3) years. Designations shall remain active for three years provided no substantive changes or variances have occurred. The Department may perform periodic trauma center audit/reviews at each designated trauma center. The State Health Officer (SHO) may extend trauma center designations for one (1) year.

2. After completion of a designation survey, the team conducting the survey will make a recommendation to the Department for designation. The Director of the Bureau of Acute Care Systems (BACS) will present the survey report and the team’s recommendation to the state Trauma System Medical Director (TSMD). The TSMD may seek advice or further recommendation from the Mississippi Trauma Advisory Committee (MTAC) during its executive session, if the TSMD disagrees with the recommendations of the team; otherwise the TSMD may make direct recommendations to the State Health Officer.

3. The Director of BACS will prepare a memorandum detailing the recommendations of the team and signed by the TSMD for the State Health Officer and will forward the memorandum and the designation letter to the State Health Officer for signature.

Once signed, the letter will be sent to the hospital receiving the survey.

Rule 1.2.7. Trauma/Burn/Tertiary Pediatric Trauma Center Designation Renewal: Hospitals desiring renewal of designation must submit an application to the Department no later than 180 days prior to expiration of designation. The Department will acknowledge receipt of the application within 60 days to the applicant hospital and begin the designation process as provided by this regulation.

Rule 1.2.8. Loss of Required Trauma Care Capability: Any designated trauma/burn center that loses, either permanently or temporarily, physician, nursing, or other patient care specialties required by this regulation, shall report that loss to the Department utilizing the state approved reporting system. If the loss will result in diminished capability for a period longer than 30 days, the facility must also submit a Corrective Action Plan (CAP) that addresses how the facility will become compliant.

Rule 1.2.9. Suspension of Trauma Center Designation: The State Health Officer may suspend the trauma center designation of any hospital for:

1. Documented conditions of serious threat or jeopardy to patients’ health or welfare;

2. Failure to comply with laws or regulations;

3. Failure to satisfactorily meet the minimum requirements as a trauma center as defined by regulations for the designation level.

4. Failure to complete a Corrective Action Plan (CAP) within the timeframe specified by the Department.

Rule 1.2.10. Hospitals having their designation suspended may reapply for designation after resolution of all issues related to the suspension, and completion of a new application and survey. When a hospital’s designation is suspended or withheld, the hospital is responsible for paying the pro-rata fees as set forth in the “Play or Pay” section of these regulations from the date of suspension until the center is re-designated.

Rule 1.2.11. Change of Trauma Center Designation

1. Trauma centers will be permitted to change designation if the following conditions are met in entirety:

a. The trauma center has been surveyed and designated by the Department, the designation is current, and the trauma center is in full compliance with the Mississippi Trauma System Rules and Regulations;

b. The Department’s Trauma System Medical Director has reviewed the request and determines that there is no adverse impact to the Trauma System;

c. The Bureau of Acute Care Systems concurs with the request;

d. The State Health Officer (SHO) or designee issues the new designation.

Rule 1.2.12. Appeal Process.

1. A hospital shall have 30 calendar days from the date of notification of suspension of trauma center designation to appeal the decision, in writing, to the Department and to request a due process hearing.

2. The Director of the Bureau of Acute Care Systems, upon receipt of a request for a hearing, shall set a date no more than 30 calendar days from the receipt of the request for a hearing.

3. The hearing officer appointed to conduct the hearing shall be a person appointed by the Director of the Office of Health Protection. A stenographic record of the hearing shall be made by a certified reporter/stenographer. The record shall consist of all sworn testimony taken, written, documentary or other relevant evidence taken at said hearing.

4. Within 30 calendar days of the receipt by the hearing officer of the certified record, he/she shall render findings of fact and conclusions of law contained in an order. The order so produced by the hearing officer shall be the final order of the Mississippi State Department of Health and shall be appealable to a court of competent jurisdiction.

5. If the decision of the Department is unfavorable to the hospital, the hospital may apply for trauma center designation at another level but must pay all costs associated with the survey.

Rule 1.2.13. Partial Capability: Any trauma center that chooses to offer patient care services that are above the level of their trauma center designation, must comply with the standards for the higher level of designation, including response times for physician specialties, protocols and procedures, performance improvement processes, and equipment, training, and personnel as listed on the Essentials and Desirables (“E&D”) chart of the appropriate trauma center level. Additionally, the higher patient care must be reviewed by the hospital performance improvement committee, the statewide Performance Improvement Committee and the Department.

Subchapter 3 Financial Support for the Trauma System

Rule 1.3.1. Trauma Care Trust Fund: The Trauma Care Trust Fund (TCTF) shall serve as the financial support mechanism for development of the Mississippi Trauma System. The Department shall contract with a vendor, which shall provide specific services, including but not limited to TCTF distribution to designated trauma centers and EMS agencies, administrative support and trauma education activities, which shall be further delineated in the annual contract with MSDH.

Rule 1.3.2. Trauma Care Trust Fund Eligibility

1. Trauma Care Trust Fund (TCTF) distribution shall be provided to designated Level

I, II, and III Trauma Centers, designated Burn Centers, eligible physicians and eligible licensed ambulance services through the approved vendor. Designated Level IV Trauma Centers will receive an annual stipend for satisfactory participation in the Mississippi Trauma System. To be eligible for trauma funding as provided for in these rules, EMS providers must comply with the Mississippi Guidelines for Field Triage of Injured Patients and transport patients to the most appropriate trauma center (determined through Trauma Registry data reporting and statewide Performance Improvement Committee). Eligible expenditures for EMS providers are listed in the Trauma System Audit Manual posted on the MSDH Website.

2. Level I Trauma Centers and stand-alone Tertiary Pediatric Trauma Centers located in a state contiguous to the State of Mississippi that participate in the Mississippi Trauma System and have been designated by the Department shall be eligible to receive distributions from the TCTF.

Rule 1.3.3. Trauma Care Trust Fund Distribution Formula

1. Funds for the administration and development of the Trauma System will be budgeted from available funds from the TCTF. Examples of administrative and development costs include but are not limited to salaries and benefit costs for personnel (full-time and part-time equivalents) who expend a portion of their time in trauma care administration and/or development, travel and training costs for such personnel, use of trauma care physicians and/or other trauma professionals used in the development and/or maintenance of the trauma system, development and/or maintenance of accounting and auditing of the use and distribution of the TCTF, costs of vendors involved in administrative and educational activities, , and the costs associated with the development and/or implementation of the Trauma System (i.e., telecommunication systems, data storage and/or retrieval systems, advertising, equipment, etc.).

2. Eighty-five percent (85%) of the remaining funds from the TCTF are allocated to participating Level I, II and III Trauma Centers and Burn Centers which shall further allocate at least thirty percent (30%) of the funds received to eligible physicians.

3. Fifteen percent (15%) of the remaining funds from the TCTF are allocated to eligible licensed ambulance services that provide pre-hospital care to trauma victims.

Rule 1.3.4. Trauma Care Trust Fund Distribution Calculation: Amounts to be disbursed from the

Trauma Care Trust Fund (TCTF) shall be calculated as follows:

1. On or about July 31 and January 31 each year, or at such other times as the State Health Officer may direct, the Bureau of Acute Care Systems shall obtain a financial report showing the fund balance in the TCTF.

2. To obtain the amount to be distributed, the following amounts will be subtracted from the fund balance:

• One half of an amount to be determined by the Department for the administrative expenses of the Department (Bureau of Acute Care Systems, Trauma System of Care) as of the date of the calculation;

• One half of an amount not to exceed Ten Thousand Dollars ($10,000) for each

Level IV Trauma Center which has completed at least one year of satisfactory participation in the Mississippi Trauma System as of the date of the calculation (annual stipend);

• One half of an amount to be determined by the Department for MSTF administrative costs and costs of budgeted educational expenses as of the date of the calculation.

3. The amount remaining after the above administrative payments have been calculated, reserved and/or expended, shall be distributed according to the TCTF formula.

Rule 1.3.5. Trauma Card Trust Fund Ambulance Service Distribution

1. Fifteen percent (15%) of the amount remaining after the expenses noted in Rule 1.3.4 have been determined shall be distributed to the vendor used for fund distribution.

The vendor shall further distribute said funds to eligible licensed ambulance services.

Eligible licensed ambulance services shall be those basic or advanced life support ambulance services licensed by the Bureau of Emergency Medical Services to provide emergency pre-hospital trauma care. In the event there is more than one eligible licensed ambulance service active in one county, funding for the ambulance services in said county shall be distributed to both services based on call volume or other appropriate criteria as determined by the Department.

2. For purposes of determining amounts to be distributed to licensed ambulance services pursuant to this rule, the following definitions shall apply:

• Census – the most recent decennial United States Census.

• Small Counties – those counties with a population of less than 15,000 as identified in the most recent Census.

• Large Counties – those counties with a population greater than or equal to 15,000 as identified in the most recent Census.

• Total Fund Balance – that portion of the TCTF that is allocated to licensed ambulance services.

• Small County Population Percentage – the sum of Small Counties population as a percent of the total state population as reflected by the Census.

• Per Capita Portion – the portion of a Small County’s disbursement that is calculated by multiplying that county’s Small County Population Percentage by the Total Fund Balance.

• Dedicated Portion – the portion of a Small County’s disbursement that is calculated by subtracting an amount from the Total Fund Balance and dividing among the Small Counties so that each Small County receives an equal disbursement that is equal to or less than the Large County with the lowest population.

• Adjusted Population – determined by adding the population from the Small Counties and subtracting that sum from the state’s total population.

• Adjusted Fund Balance – calculated by subtracting the amount dedicated for the smaller counties from the total fund balance.

Per Capita Portion:

Multiply the Small Counties Population Percentage by the Total Fund Balance.

Per Capita portion = (Small Counties Population Percentage X Total Fund Balance)

Dedicated Portion:

The Dedicated Portion is calculated by subtracting an amount from the Total Fund Balance and adding it to the Per Capita Portion so that the sum of the Per Capita Portion plus the Dedicated Portion is divided by the number of Small Counties, AND the result is less than or equal to the Disbursement received by the Large County with the population closest to or equal to 15,000.

Dedicated Portion = [(Per Capita Disbursement + Dedicated Portion) / (Number of Small Counties)] < / = Disbursement of the Large County with lowest population

The Disbursement for small counties is calculated by adding the Per Capita and Dedicated Portions.

Disbursement (for Small Counties) = (Per Capita Portion) + (Dedicated Portion)

The amount to be disbursed for each Large County is calculated as follows:

Disbursement = (census population) / (Adjusted population) X (Adjusted Fund Balance)

Source: Miss. Code Ann. § 41-59-75

Rule 1.3.6. Trauma Care Trust Fund Hospital Fixed Distribution

1. Eighty-five percent (85%) of the amount remaining after the expenses noted in

Rule 1.3.4 have been determined shall be distributed to the vendor used for fund distribution. The vendor shall further distribute said funds to participating trauma centers as prescribed by the accounting firm.

2. Thirty percent (30%) of the amount reserved for distribution to hospitals shall be distributed according to a “Fixed Distribution,” based on the designated level of each eligible trauma center.

3. For purposes of determining amounts to be distributed to trauma centers pursuant to this rule, the following definitions shall apply:

• Number of Facilities – the number of licensed acute care facilities designated as a Level I, Level II or Level III Trauma Centers

• Relative Weights – Level I shall equal 100%; Level II shall equal 87.5%;

Level III shall equal 62.5%

• Calculated Weight – Equals the number of facilities designated at a particular level of trauma center multiplied by the relative weight.

• Total Weight – equals the sum of calculated weights

• Disbursement by Hospital Type – equals Total Hospital Fixed Fund /

Total Weight X Relative Weight

• Total Disbursement by Hospital Type – equals the sum of Disbursement by Hospital Type

4. To calculate the Hospital Fixed Distribution, the following formula is used :

• Multiply the number of facilities in each category (Level I, Level II and Level

III) by the relative weights of each category. The product of this operation shall be the calculated weight of each type facility.

• Sum the relative weights to obtain the “calculated weight.”

• Divide the total Hospital Fixed Distribution amount by the product of the sum of the relative weights (“calculated weight”) and the relative weight assigned to that category.

• The result is the amount to be distributed to each facility of that particular type (Level I, Level II or Level III).

Rule 1.3.7. Trauma Care Trust Fund Hospital Variable Distribution

1. Fifty percent (50%) of the amount reserved for distribution to hospitals shall be distributed according to a “Variable Distribution” formula.

2. Using patient data collected in the Trauma Registry, assign all trauma cases of each Level I, Level II, and Level II Trauma Center an ISS severity index and category of A, B, C, or D according to the following table:

ISS

ISS Severity Index

ISS Severity Category

1-9 1.02 A 10-15 2.02 B 16-24 3.80 C >24 6.57 D

3. Using patient data collected in the Trauma Registry, Calculate the number of cases treated by each trauma center which fall within each ISS Severity Category.

4. Multiply the total number of ISS Severity Category A cases by the relative value assignment of 1.02 to arrive at the total number of Category A points.

5. Multiply the total number of ISS Severity Category B cases by the relative value assignment of 2.02 to arrive at the total number of Category B points.

6. Multiply the total number of ISS Severity Category C cases by the relative value assignment of 3.80 to arrive at the total number of Category C points.

7. Multiply the total number of ISS Severity Category D cases by the relative value assignment of 6.57 to arrive at the total number of Category D points.

8. Add the points from Categories A, B, C, and D to arrive at a total number of points for each trauma center.

9. Sum the number of points from all categories and all hospitals to arrive at a total number of points for all trauma centers.

10. Take the number of points for each hospital and multiply that number by the total dollar amount for the 50 percent of the TCTF available for distribution to participating, eligible trauma centers. Take the product of that calculation and divide the resulting number by the total number of points for all trauma centers.

11. The resulting quotient is the dollar amount of the Hospital Variable Fund to be distributed to that trauma center.

12. Sum all the amounts to be distributed pursuant to the Hospital Variable Fund

Calculation. The sum of all distributions should not exceed fifty percent (50%) of the eighty-five percent (85%) of the TCTF available for distribution to hospitals.

Rule 1.3.8. Trauma Care Trust Fund Burn Center Distribution: Five percent (5%) of the amount reserved for distribution to hospitals shall be distributed to designated burn centers within the Trauma System. If more than one burn center is operating within the system, the 5% will be distributed based on a pro-rata share of patients as determined by Trauma Registry inputs. (Note: Trauma patients counted toward burn center distribution cannot be used to determine hospital variable distribution.) If no hospital has been designated as a burn center at the time of the distribution, the 5% shall be included in the Hospital Fixed Distribution.

Rule 1.3.9. Play or Pay General Requirements:

1. Every Mississippi licensed acute care facility (hospital) having an organized emergency service or department shall participate in the Mississippi Statewide Trauma System. Every hospital having an organized emergency service or department shall submit data to the Trauma Registry.

2. Hospitals with the potential to serve as Level I, II, or III Trauma Centers must participate at the highest trauma designation level consistent with its capabilities as assessed by the Department.

3. Any hospital determined capable of participating as a Level IV Trauma Center may make application to be designated as a Level IV Trauma Center. A Level IV Trauma Center is required to submit data to the Trauma Registry and is eligible for $10,000 for administrative costs as a participant in the Trauma System.

Rule 1.3.10. Trauma Center Annual Capability Assessment:

1. Each year, all licensed acute care facilities shall complete the Trauma Center Annual Capability Assessment Survey, which is available via the Department’s website. The facility will attest to the presence or absence of clinical services.

Based on the facility’s response, as well as other supporting evidence, the Department shall render an assessment of the facility’s potential to participate in the Trauma System.

2. Each facility shall complete and return the Trauma Center Annual Capability

Assessment Survey by July 31st each year.

3. On or about the first week of September an invoice and application (as applicable) will be sent by the Department to each facility in response to their respective survey.

Rule 1.3.11. Annual Assessment Criteria: For the purposes of the annual capability assessment, if the trauma center has the resources to provide the following respective clinical services 24 hours per day, seven days per week, the trauma center will be assessed as follows:

1. Level I Trauma Center required services

• Emergency Medicine

• General Surgery

• Orthopedic Surgery

• Neurological Surgery

• Anesthesia

• Post Anesthesia Care Unit (PACU)

• Intensive Care Unit (ICU)

• Surgical Residency Program

2. Level II Trauma Center required services

• Neurological Surgery

3. Level III Trauma Center required services

Rule 1.3.12. Play or Pay Non-Participation Fee

1. Any hospital that chooses not to participate in the Trauma Care System as a Level I, II, or III Trauma Center, or participates at a level lower than the level at which it is capable of participating, as determined by the Department, or fails to maintain or becomes incapable of maintaining its designation as a Level I, II or III Trauma Center, or has its designation as a Level I, II, or III Trauma Center suspended by the Department, or becomes “non-designated” as a Level I, II, or III Trauma Center, shall be assessed and shall pay a non-participation fee as defined by this regulation.

• All fees are due and payable annually before January 1 of each year. Any event above, occurring during the calendar year shall result in the hospital owing a pro- rata portion of the fee. The fee assessed shall be pro-rated on a monthly basis. The fee shall be paid in full upon written notification from the Department.

2. The fee schedule shall be reassessed and adjusted, as necessary, by the

Mississippi Trauma Advisory Committee.

3. The fee schedule is as follows:

Current Level Projected Level Fee for Non-Participation Non-Designated Level II $1,492,000.00 Non-Designated Level III $ 758,000.00 Level III to Level II $ 423,500.00 Level IV to Level II $1,492,000.00 Level IV to Level III $ 758,000.00

Rule 1.3.13. Play or Pay Appeal Process

1. Following the receipt of an invoice from the Department for a Non-

Participation fee, the hospital assessed the fee may request a due process hearing on the assessment. Any such request for hearing must be filed by the assessed facility with the Director of the Bureau of Acute Care Systems, Mississippi State Department of Health, within thirty (30) days of the date of the assessment.

2. The date of the assessment is defined as the date which the assessment is placed in the United States Mail, postage pre-paid, addressed to the facility assessed, at the address furnished by the hospital to the Trauma Registry, or to the address published by the party as its usual and customary business address.

The date of the postmark shall be prima facie evidence of the date of the assessment.

3. The Director of the Bureau of Acute Care Systems, upon receipt of a valid, timely request for a hearing, shall set a date no more than thirty (30) calendar days from the receipt of the request for hearing.

4. The hearing officer appointed to conduct the hearing shall be a person chosen or appointed by the Director of the Office of Health Protection. A stenographic record of the hearing shall be made by a certified reporter/stenographer. The record shall consist of all sworn testimony taken, written, documentary or other relevant evidence taken at said hearing.

5. The only issues for adjudication are:

• The timeliness of notice of the assessment and delivery of the same;

• The trauma classification of the party; and

• The calculation of the amount of the assessment.

6. Within thirty (30) days of the receipt by the hearing officer of the certified record, he or she shall render findings of fact and conclusions of law contained in an order. The order so produced by the hearing officer shall be the final order of the Mississippi State Department of Health and shall be appealable to a court of competent jurisdiction.

7. If no appeal from the final order is taken within twenty (20) days of the date of the order, the party assessed shall pay on or before the twentieth (20th) day following the date of the order the entire fee assessed.

Rule 1.3.14. Delinquent Payments to the Trauma Care Trust Fund:

1. If a hospital fails to submit an application for designation as a trauma center and fails to pay the required fee for Non-Participation by January 1, a letter from the Department will be sent via certified mail to the administrator of the hospital informing that payment is due no later than 30 days from the delivery date of the letter, or that the a request for a due process hearing must be received at the Department no later than 30 days from the delivery date of the letter.

2. If the administrator fails to respond, or comply with the requirements of the certified letter, a letter will be sent by the Bureau of Acute Care Systems to the Bureau of Health Facilities Licensure and Certification documenting an alleged violation of the Minimum Standards for the Operation of Mississippi Hospitals, specifically that the governing body of the hospital, through its administrator, failed to take all reasonable steps to comply with all applicable federal, state and local laws and regulations. A copy of the letter will be sent to the hospital administrator via certified mail.

3. The Bureau of Health Facilities Licensure and Certification will conduct an investigation of the alleged violation(s). If a finding of Substantiated is returned, the Bureau of Acute Care Systems will recommend to Licensure and Certification that the hospital’s license be revoked. A copy of this recommendation will be sent to the hospital administrator via certified mail. A copy of recommendation will also be sent to the Centers for Medicare and Medicaid Services (CMS).

4. Once the hospital has satisfied the requirements of this Sub-chapter, the Bureau of

Acute Care Systems will send a letter to License and Certification recommending reinstatement of the hospital’s license with/without restrictions, as appropriate. A copy of this recommendation will be sent to the hospital administrator via certified mail and to CMS.

5. If a hospital elects to participate at a level lower than the assessed capability and fails to pay the required fee for Non-participation by January 1, a letter from the Department will be sent via certified mail to the administrator of the hospital informing that payment is due no later than 30 days from the delivery date of the letter, or that the a request for a due process hearing must be received at the Department no later than 30 days from the delivery date of the letter.

6. If the administrator fails to respond, or comply with the requirements of the certified letter, a letter will be sent by the Bureau of Acute Care Systems to the Bureau of Health Facilities Licensure and Certification documenting an alleged violation of the Minimum Standards for the Operation of Mississippi Hospitals, specifically that the governing body of the hospital, through its administrator, failed to take all reasonable steps to comply with all applicable federal, state and local laws and regulations. A copy of the letter will be sent to the hospital administrator via certified mail.

7. The Bureau of Health Facilities Licensure and Certification will conduct an investigation of the alleged violation(s) and if a finding of Substantiated is returned, the Bureau of Acute Care Systems will recommend to Licensure and Certification that the hospital’s license be revoked. A copy of this recommendation will be sent to the hospital administrator via certified mail. A copy of recommendation will also be sent to CMS.

8. Once the hospital has satisfied the requirements of this Sub-chapter, the Bureau of

Acute Care Systems will send a letter to License and Certification recommending reinstatement of the hospital’s license with/without restrictions as appropriate. A copy of this recommendation will be sent to the hospital administrator via certified mail and to CMS.

Subchapter 4 Mississippi State Trauma Registry

Rule 1.4.1. Applicability

1. All Mississippi-licensed hospitals which have an emergency service or department shall participate in the Trauma Registry data collection process, whether or not they participate in the Trauma System. All out-of-state hospitals designated as Mississippi trauma centers shall participate in the Trauma Registry. Specialized treatment centers, either in-state or out-of-state, that have contracts with the Department to provide care to Mississippi trauma/burn patients, shall participate in the Trauma Registry.

2. All trauma data collection instruments shall include the collection of both pre-hospital and hospital patient care data and shall be integrated into the Department's data management systems. Trauma registry inclusion criteria and the data dictionary can be found on the Department’s website.

Rule 1.4.2. Timeliness of Submissions: Trauma Registry data shall be submitted by all hospitals to the Department no later than two (2) months plus six (6) days after the end of the current month. For example, Trauma Registry data for the month of January is due no later than April 6th.

Rule 1.4.3. Trauma Registrar staffing: Each trauma center shall have a sufficient number of trauma registrars to ensure all registry entries are submitted on time and are accurate. Registrars must complete initial training of sixteen (16) hours within six

(6) months of hire/assignment. All registrars must complete eight (8) hours of registry specific continuing education annually.

Source: Miss. Code Ann §41-59-5

Subchapter 5 Administrative and Educational Support

Rule 1.5.1. Administrative and Educational Support Activities

1. The Mississippi Trauma System of Care Plan provides for a mandatory trauma system that is inclusive, matching appropriate resources and responses to the needs of trauma patients. The Plan provides a mechanism for improving community health through an organized system of injury prevention, acute care and rehabilitation, which shall be fully integrated into the statewide public health system. The Plan calls for making use of a vendor or vendors for administrative and/or educational services as required for the efficacy of the program. Any vendor used for said purpose shall function under contract with

MSDH.

Subchapter 6 Inter-facility Transfers of Trauma Patients

Rule 1.6.1. Inter-facility Transfers

1. Patients may be transferred from trauma centers to other trauma centers and/or specialty referral centers provided that any such transfer is medically prudent, as determined by the transferring trauma center physician of record and is conducted by the appropriate level of emergency medical service provider.

2. Trauma centers shall develop written criteria for consultation and transfer of patients needing a higher/specialty level of care. Trauma center/specialty referral centers that repatriate trauma patients shall provide data required by the Trauma Registry to the receiving trauma center.

3. Trauma centers/specialty hospitals receiving transferred trauma patients shall provide written feedback to the transferring facility and shall participate in the state performance improvement process.

Chapter 2 Performance Improvement and Patient Safety

Subchapter 1 Authority and Scope

Rule 2.1.1. Each designated trauma center shall have a Performance Improvement and Patient Safety

(PIPS) program. The PIPS program shall be multidisciplinary in nature with every member of the trauma team playing a role in PIPS program.