Ariz. Admin. Code § R9-22-2104 - Additional Trauma and Emergency Services Payments under the Section 1115 Waiver
A.
Notwithstanding R9-22-2101(D), for the reporting years ending June 30, 2011 and
June 30, 2012, the Administration shall distribute an amount equal to the
balance of the Trauma and Emergency Services fund in the following manner:
1. Ninety percent of the amount shall be
distributed to Level I trauma centers based upon each center's pro rata share
of each center's acuity-adjusted volume as a percentage of the total
acuity-adjusted volume for all centers in the state. The acuity-adjusted volume
is calculated by multiplying the Injury Severity Score employed by trauma.org
by the number of trauma cases at that level treated at the center during the
reporting year. Hospitals shall report trauma scores and case volume on a
worksheet prescribed by the Administration.
2. Ten percent of the amount shall be
distributed proportionately to hospitals that had an emergency department from
July 1 through June 30 of the reporting year based the pro rata share of each
hospital's cost of emergency care as a percentage of the total statewide cost
of emergency care provided by hospitals as reported on the Worksheet B, column
27, line 61 of the hospital's most current Medicare Cost Report as of January
31 following the end of each reporting year.
B. For the reporting years ending June 30,
2011 and June 30, 2012, the Administration shall distribute an amount equal to
the federal financial participation made available under the section 1115
waiver for the purpose of making payments for unrecovered trauma and emergency
services as follows:
1. Thirty percent of
such funds to a Level I trauma center, in amounts calculated in the same manner
as described in subsection (A)(1) of this Section, for any unrecovered trauma
center readiness costs not reimbursed under subsection (A) of this
Section;
2. Thirty percent of such
funds to a hospital having an emergency department from July 1 through June 30
of the reporting year, in amounts calculated in the same manner as described in
subsection (A)(2) of this Section, for any unrecovered emergency services costs
not reimbursed under subsection (A) of this Section; and
3. Forty percent of such funds to rural
hospitals, as defined in R9-22-718 that are not Level 1 trauma centers as
defined in R9-22-2101(F), having an emergency department from July 1 through
June 30 of the reporting year, in amounts calculated in the same manner as
described in subsection (A)(2) of this Section, for any unrecovered emergency
services costs not reimbursed under subsections (A) and (B)(2) of this
Section.
C. For the
reporting years ending June 30, 2011 and June 30, 2012, payments made under
this Article shall not be made in an amount that results in aggregate payments
to the hospital by the Administration and contractors exceeding of the upper
payment limit for the hospital services as calculated in accordance with 42 CFR
447.
D. For the reporting years
ending June 30, 2011 and June 30, 2012, to ensure compliance with subsection
(C), payments under this Article shall be reconciled to the federal fiscal year
that is two years subsequent to the payment.
E. Any payments that are determined under
subsection (D) to exceed the limit in subsection (C) shall be distributed as
described in this Article to hospitals that have not received payments in
excess of the limit in subsection (C).
Notes
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