Unreimbursed medical trauma care services.

WORKING DRAFT

ORIGINAL HOUSE

BILL

NO.
0170

ENROLLED ACT NO. 46, HOUSE OF REPRESENTATIVES

FIFTY-EIGHTH LEGISLATURE OF THE STATE OF
WYOMING
2006 BUDGET SESSION

AN ACT relating to medical care; extending payment program to hospitals for unreimbursed trauma care, as specified; expanding unreimbursed trauma care services eligible for reimbursement from the state to include ambulance services;
and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.

(a)

As used in this act:

(i)

"Acute care hospital" means a hospital licensed in
Wyoming
pursuant to W.S. 35
‑
2
‑
901 through 35
‑
2
‑
911 and which provides acute patient care;

(ii)

"Ambulance service" means an ambulance service licensed in Wyoming pursuant to W.S. 33
‑
36
‑
102 through 33
‑
36
‑
113 and which provides emergency medical transportation to hospitals or emergency rooms;

(iii)

"Department" means the
Wyoming
department of health;

(iv)

"Incident" means an admission, both inpatient and outpatient, involving traumatic care for an individual patient within a one (1) year period to a single hospital. Admissions of the same patient for causes not directly related to an earlier admission shall be considered a separate incident;

(v)

"Trauma care services" means services to patients with at least one (1) injury diagnosis code, using the International Classification of Diseases, 9
th
Edition, from 800.0 through 904, 925 through 929, 940 through 959.9, and 994.7, plus

at least one (1) of the following:

(A)

Hospitalization for one (1) calendar day;

(B)

Admission to the intensive care unit or monitored bed unit;

(C)

Cardiac or respiratory arrest on route to the hospital or emergency room;

(D)

Dead on arrival at the facility;

(E)

Transfer from or to another acute care hospital;

(F)

Admission directly from the emergency room to the operating room;

(G)

Trauma team activation;

(H)

Meets prehospital triage criteria;

(J)

Ambulance services providing patient transportation to a hospital or emergency room.

(b)

Acute care hospitals or ambulance services shall be reimbursed on a per incident basis, subject to the following:

(i)

There is compliance with the reporting requirements of the
Wyoming
trauma care program registry before the request for reimbursement;

(ii)

Reimbursement shall be available for costs incurred after June 30, 2006 and before July 1, 2007;

(iii)

Requests for reimbursement may be submitted to the health department for payment only after one hundred eighty (180) days have elapsed from the date the bill for the services rendered was sent to the patient or his representative.

(c)

The department shall promulgate rules and regulations to administer this program on behalf of the state of
Wyoming
. The rules and regulations shall include provisions for:

(i)

Ensuring that reimbursements do not exceed the appropriated funds;

(ii)

Limiting reimbursement to the necessary support of the poor;

(iii)

Preventing duplication from this appropriation and insurance;

(iv)

Reimbursing hospitals for trauma service costs and ambulance services for transporting patients to a hospital or emergency room.

(d)

The department may contract with a fiscal agent to make the actual payments and conduct any necessary audits of reimbursement requests. Reimbursement requests shall be made in a form and manner prescribed by the department. The department or its agent on its behalf may request any documentation it deems necessary to support any request for reimbursement.

(e)

The department shall not reimburse any one (1) acute care hospital or ambulance service in a cumulative amount greater than twenty-five percent (25%) of the appropriation in section 2 of this act. However, if the department reasonably concludes as of May 31, 2007, that the appropriation will not be fully expended, the remaining funds may be used to reimburse hospitals on a pro rata basis above the twenty-five percent (25%) limit of this subsection, subject to the requirements of subsection (b) of this section.

Section 2.

Notwithstanding W.S. 9
‑
4
‑
207, funds
appropriated by 2005 Session Laws, chapter 160, for unreimbursed trauma care
shall not lapse at the end of the biennium ending June 30, 2006 but shall remain available for expenditures until June 30, 2007, subject to the requirements of
2005 Session Laws, chapter 160
and paragraphs (b)(i) and (iii) of section 1 of this act.

Section 3.
This act is effective July 1, 2006.

(END)

Speaker of the House

President of the Senate

Governor

TIME APPROVED: _________

DATE APPROVED: _________

I hereby certify that this act originated in the House.

Chief Clerk

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