WAC 246-976-485   Designation of facilities to provide trauma care services.  (1) The department designates trauma services as part of the comprehensive, statewide emergency medical services and trauma care system. This section and WAC 246-976-490 describe the designation process. WAC 246-976-530 through 246-976-890 identify standards for trauma services. The department uses a competitive process to select designated services, including:

     (a) An application schedule. You will have at least ninety days to complete the application;

     (b) A description of the documents you must submit to demonstrate that you meet the standards;

     (c) An on-site review fee schedule. You must pay any required fees at least thirty days before an on-site review;

     (d) The department's evaluation criteria; and

     (e) The department's decision criteria.

     (2) To apply for trauma service designation, you must:

     (a) Send a notice of intent to the department by the time required in the application schedule;

     (b) Submit a completed application by the time required in the application schedule. If you are applying for multiple designation, you must submit a separate application for each level and category of designation for which you are applying.

     If you represent more than one facility applying for joint designation, you must submit a single application for each level and category. The department's evaluation of joint applications will use the same criteria as for a single facility designation. To be considered for joint designation, your joint trauma service must have:

     (i) A single trauma service director;

     (ii) A single multidisciplinary committee with representation from all participating facilities;

     (iii) A single set of common policies and procedures;

     (iv) A predetermined facility rotation schedule;

     (v) A single, central trauma registry with a common methodology for abstraction and input of trauma data; and

     (vi) A single, joint QI program in keeping with the goals of WAC 246-976-881 including joint peer review and joint systems review.

     (c) Provide the department's on-site review team access to your facility, staff, and all documents concerning trauma care. This will include at least your standards of care, policy and procedures, patient care records, trauma quality assurance/improvement materials, and other relevant documents.

     (3) The department must conduct an on-site review of your facility before you can be designated as level I, II or III trauma care service, or level I, II or III pediatric trauma care service. The department will use a multidisciplinary team to conduct this review.

     (a) For level I and II services, the department will only choose members for the review team who live or work outside your state.

     (b) For level III services, the department will only choose members for the review team who live or work outside your region.

     (c) The department will provide you with the names of members of the review team. You should send any objections to the department within ten days of notification.

     (d) The team will give an oral report of preliminary findings before leaving your facility.

     (e) The department and the team will maintain confidentiality of information, records, and reports developed pursuant to on-site reviews in accordance with the provisions of RCW 70.41.200 and 70.168.070.

     (f) The department will conduct an on-site review within eighteen months of designating a joint service, to confirm that you meet the requirements of this chapter. This requirement shall not be construed to limit the department's right to conduct an on-site review at any earlier or later time, or to limit its authority under WAC 246-976-490 to suspend or revoke designation for cause at any time prior to the on-site review of the jointly designated trauma care service.

     (4) The department may conduct an on-site review of your facility if you applied for designation as a level IV or V trauma care service, as a level I-III trauma rehabilitation service, or as a level I-pediatric trauma rehabilitation service.

     (5) After designation as a trauma service, you may ask the department to conduct an on-site survey for technical assistance. The department may require you to reimburse its costs for conducting the survey.

     (6) The department will designate the health care facilities it considers most qualified to provide trauma care services. The decision to designate will be based on at least the following:

     (a) Evaluation of all applications submitted;

     (b) Recommendations from the on-site review team;

     (c) Trauma patient outcomes during the previous designation period;

     (d) The impact of designation on the effectiveness of the trauma care system;

     (e) Expected patient volume of the area;

     (f) The number, levels, and distribution of designated health care facilities established in the state and regional EMS/TC plans;

     (g) Ability of each applicant to comply with goals of the state and regional EMS/TC plans; and

     (h) Each applicant's compliance with its designation contract during the previous designation period.

     (7) The department will notify you in writing of its designation decision. It will also provide you with a written report summarizing its review of your application, any on-site review findings, and any decisions:

     (a) In regions where there is competition for designation, the department will send you the report within ninety days of announcing its decisions. There is competition for designation in any region where the number of applications for a level and type of designation is more than the maximum number of services identified in the state plan.

     (b) In regions where there is no competition, the department will send you the report within ninety days of the on-site review for levels I - III or within thirty days of announcing its designation decision for levels IV and V.

     (8) The department will notify regional EMS/TC councils of the name, location, and level of services that have been designated in their regions.

     (9) The department will not approve your application if it finds that your facility:

     (a) Is not the most qualified applicant, if there is competition for designation;

     (b) Does not meet the requirements of this chapter for the level you applied for;

     (c) Does not meet the requirements of the approved regional plan;

     (d) Has made a false statement about a material fact in its application for designation; or

     (e) Refuses to allow the department to inspect any part of your facility that relates to the delivery of trauma services, including records, documentation, or files.

     (10) If the department denies an application for trauma service designation, the department will notify you in writing, including the reasons for its action and explaining your rights. You may appeal the department's decisions. Your appeal must follow the requirements of chapter 34.05 RCW and chapter 246-10 WAC. Send your appeal to the adjudicative clerk's office at the address indicated on the notice of decision.

     (11) The department may:

     (a) Consider applications from facilities located and licensed in adjacent states in the same manner as applications received from facilities located and licensed in Washington;

     (b) Consider the administrative findings, conclusions and determination of an adjacent state to determine if you meet Washington standards. The department may request additional information. The department will base its decision on these considerations only if:

     (i) There is no competition in the region for designation at the level/category you applied for; and

     (ii) Your facility is located in an adjacent state that has an established trauma care system, with standards that meet or exceed Washington standards; and your facility is designated by your state to provide trauma service;

     (c) Provisionally designate trauma services that are not able to meet all the requirements of this chapter, if this is necessary to ensure adequate trauma care in an area. The provisional designation will not be for more than two years;

     (d) Consider additional applications without regard to the schedule, if this is needed to ensure adequate coverage according to the state plan.

     (12) You and the department must agree to a contract to provide trauma services. The contract will include at least:

     (a) Your authority to provide trauma services for a three-year period;

     (b) Both the department's and your contractual and financial requirements and responsibilities;

     (c) Allowance for the department to monitor your compliance with trauma service standards;

     (d) Allowance for the department access to discharge summaries for trauma patients, patient care logs, trauma patient care records, hospital trauma care quality assurance/improvement materials, including minutes, and other relevant documents;

     (e) A requirement for confidentiality of information relating to individual patient's, provider's, and facility's care outcomes.

     (13) The department will notify all interested parties of the application process and schedule at least one hundred fifty days before the expiration of designation in each region.



[Statutory Authority: RCW 70.168.060 and 70.168.070. 04-01-041, § 246-976-485, filed 12/10/03, effective 1/10/04. Statutory Authority: Chapter 70.168 RCW. 98-04-038, § 246-976-485, filed 1/29/98, effective 3/1/98.]