| (a) The Emergency Medical Services (EMS)/Trauma Systems
Section recommends to the Commissioner of the Department of State
Health Services (commissioner) the designation of an applicant facility
(facility) as a trauma facility at the level for each location of
a facility the department deems appropriate. Trauma designation surveys
conducted on or before August 31, 2025, are evaluated on the requirements
of this section. For surveys conducted on or after September 1, 2025,
see §157.126 of this subchapter (relating to Trauma Facility
Designation Requirements Effective on September 1, 2025) for the requirements.
(1) Comprehensive (Level I) trauma facility designation--The
facility, including a free-standing children's facility, meets the
current American College of Surgeons (ACS) essential criteria for
a verified Level I trauma center; meets the "Advanced Trauma Facility
Criteria" in subsection (x) of this section; actively participates
on the appropriate Regional Advisory Council (RAC); has appropriate
services for dealing with stressful events available to emergency/trauma
care providers; and submits data to the State Trauma Registry.
(2) Major (Level II) trauma facility designation--The
facility, including a free-standing children's facility, meets the
current ACS essential criteria for a verified Level II trauma center;
meets the "Advanced Trauma Facility Criteria" in subsection (x) of
this section; actively participates on the appropriate RAC; has appropriate
services for dealing with stressful events available to emergency/trauma
care providers; and submits data to the State Trauma Registry.
(3) Advanced (Level III) trauma facility designation--The
facility meets the "Advanced Trauma Facility Criteria" in subsection
(x) of this section; actively participates on the appropriate RAC;
has appropriate services for dealing with stressful events available
to emergency/trauma care providers; and submits data to the State
Trauma Registry. A free-standing children's facility, in addition
to meeting the requirements listed in this section, must meet the
current ACS essential criteria for a verified Level III trauma center.
(4) Basic (Level IV) trauma facility designation--The
facility meets the "Basic Trauma Facility Criteria" in subsection
(y) of this section; actively participates on the appropriate RAC;
has appropriate services for dealing with stressful events available
to emergency/trauma care providers; and submits data to the State
Trauma Registry.
(b) A health care facility is defined in this subchapter
as a single location where inpatients receive hospital services or
each location if there are multiple buildings where inpatients receive
hospital services and are covered under a single hospital license.
Each location is considered separately for designation and the department
will determine the designation level for that location, based on,
but not limited to, the location's own resources and levels of care
capabilities; Trauma Service Area (TSA) capabilities; and the essential
criteria and requirements outlined in subsection (a)(1) - (4) of this
section. The final determination of the level of designation may not
be the level requested by the facility.
(c) The designation process consists of three phases.
(1) First phase--The application phase begins with
submitting to the department a timely and sufficient application for
designation as a trauma facility and ends when the survey report is
received by the department.
(2) Second phase--The review phase begins with the
department's review of the survey report and ends with its recommendation
to the commissioner whether to designate the facility and at what
level. This phase also includes an appeal procedure governed by the
department's rules for a contested case hearing and by Texas Administrative
Procedure Act, Texas Government Code Chapter 2001, and the department's
formal hearing procedures in §§1.21, 1.23, 1.25, and 1.27
of this title (relating to Formal Hearing Procedures).
(3) Third phase--The final phase begins with the commissioner
reviewing the recommendation and ends with the commissioner's final
decision.
(d) For a facility seeking initial designation, a timely
and sufficient application must include:
(1) the department's current "Complete Application"
form for the appropriate level, with all fields correctly and legibly
filled-in and all requested documents attached, hand-delivered, or
sent by postal services to the department;
(2) full payment of the designation fee enclosed with
the submitted "Complete Application" form;
(3) any subsequent documents submitted by the date
requested by the department;
(4) a trauma designation survey completed within one
year of the date of the receipt of the application by the department;
and
(5) a complete survey report, including patient care
reviews, that is within 90 days of the date of the survey and is submitted
to the department.
(e) If a hospital seeking initial designation fails
to meet the requirements in subsection (d)(1) - (5) of this section,
the application is denied.
(f) For a facility seeking re-designation, a timely
and sufficient application must include:
(1) the department's current "Complete Application"
form for the appropriate level, with all fields correctly and legibly
filled-in and all requested documents attached, submitted to the department
one year before the expiration of the current designation;
(2) full payment of the designation fee enclosed with
the submitted "Complete Application" form;
(3) any subsequent documents submitted by the date
requested by the department; and
(4) a complete survey report, including patient care
reviews, that is within 90 days of the date of the survey and is submitted
to the department and at least 60 days before the expiration of the
current designation.
(g) If a health care facility seeking re-designation
fails to meet the requirements outlined in subsection (f)(1) - (4)
of this section, the original designation will expire on its expiration
date.
(h) The department's analysis of the submitted "Complete
Application" form may result in recommendations for corrective action
when deficiencies are noted and must include a review of:
(1) the evidence of current participation in RAC and
regional trauma and emergency health care system planning; and
(2) the completeness and appropriateness of the application
materials submitted, including the submission of a non-refundable
application fee as follows:
(A) for Level I and Level II trauma facility applicants,
the fee is no more than $10 per licensed bed with an upper limit of
$5,000 and a lower limit of $4,000;
(B) for Level III trauma facility applicants, the fee
is no more than $10 per licensed bed with an upper limit of $2,500
and a lower limit of $1,500; and
(C) for Level IV trauma facility applicants, the fee
is no more than $10 per licensed bed with an upper limit of $1000
and a lower limit of $500.
(i) When a "Complete Application" form for initial
designation or re-designation from a facility is received, the department
will determine the level it deems appropriate for pursuit of designation
or re-designation for each facility location based on: the facility's
resources and levels of care capabilities, TSA resources, and the
essential criteria for Levels I, II, III, and IV trauma facilities.
In general, physician services capabilities described in the application
must be in place 24-hours a day/7 days a week. In determining whether
a physician services capability is present, the department may use
the concept of substantial compliance that is defined as having said
physician services capability at least 90% of the time.
(1) If a facility disagrees with the level determined
by the department to be appropriate for pursuit of designation or
re-designation, it may make an appeal in writing within 60 days to
the EMS/Trauma Systems Section director. The written appeal must include
a signed letter from the facility's governing board with an explanation
as to why designation at the level determined by the department would
not be in the best interest of the citizens of the affected TSA or
the citizens of the State of Texas.
(2) If the department upholds its original determination,
the EMS/Trauma Systems Section director will give written notice of
such to the facility within 30 days of its receipt of the applicant's
complete written appeal.
(3) The facility may, within 30 days of the department
sending written notification of its denial, submit a written request
for further review. Such written appeal is submitted to the associate
commissioner, Consumer Protection Division.
(j) When the analysis of the "Complete Application"
form results in acknowledgement by the department that the facility
is seeking an appropriate level of designation or re-designation,
the facility may then contract for the survey, as follows.
Cont'd... |
