PROPOSED ORDER OF
DEPARTMENT OF HEALTH SERVICES
TO ADOPT PERMANENT RULES
The Wisconsin Department of Health Services (the “department”) proposes an order to repeal DHS 118.03 (32) (note), 118.04 (2) (c) 2. (note 1) and 118.08 (2) (a) 2. a. (note); to renumber and amend DHS 118.04 (2) (c) 2. (note 2); to amend DHS 118.03 (32), 118.03 (42), 118.04 (2) (c) 2., and 118.08 (2) (a) 2. a.; to repeal and recreate DHS 118 Appendix A; and to create DHS 118.03 (3m), (6m), (10m), (17m), (24m), (34m), (40g), (40r), 118.03 (45g) & (45r), 118.08 (2) (a) 3. c.
RULE SUMMARY
Statutes interpreted
Statutory authority
(1r) The department shall develop and implement a statewide trauma care system. The department shall seek the advice of the statewide trauma advisory council under s. 15.197 (25) in developing and implementing the system, and, as part of the system, shall develop regional trauma advisory councils. (2) The department shall promulgate rules to develop and implement the system. The rules shall include a method by which to classify all hospitals as to their respective emergency care capabilities. The classification rule shall be based on standards developed by the American College of Surgeons. Within 180 days after promulgation of the classification rule, and every 3 years thereafter, each hospital shall certify to the department the classification level of trauma care services that is provided by the hospital, based on the rule. The department may require a hospital to document the basis for its certification. The department may not direct a hospital to establish a certain level of certification. Confidential injury data that is collected under this subsection shall be used for confidential review relating to performance improvements in the trauma care system, and may be used for no other purpose.
Explanation of agency authority
The department is directed by s. 256.25 (2), Stats., to promulgate rules to develop and implement a statewide trauma care system that includes a method by which to classify all hospitals as to their respective trauma and emergency care capabilities based on standards developed by the American College of Surgeons (ACS). Related statute or rule
None.
Plain language analysis
The department is charged with developing and implementing a statewide trauma care system. Included in this charge is the classification of hospitals according to their emergency care capabilities. Hospitals are reviewed every three years based on standards developed by the ACS.
The proposed rule updates the standards used to evaluate hospitals as to their emergency care capabilities. The proposed rule updates the standards to be based on the most recent standards developed by the ACS.
No reasonable alternatives exist to rulemaking. Without proposed revisions to Chapter DHS 118, the classification criteria for Wisconsin hospitals will be outdated and not in accordance with the latest recommendations from the ACS. Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Comparison with rules in adjacent states
Adjacent states generally have a similar hospital classification process to Wisconsin. Most states require Level I and II trauma care facilities to be verified by the ACS and allow Level III and IV trauma care facilities to be verified by the ACS or by the appropriate department in each state.
Illinois:
Illinois statute confers on the Illinois Department of Public Health the authority and responsibility to designate applicant hospitals as Level I or Level II trauma centers. 210 ILCS 50/3.90(b)(4). The Illinois Department of Health must attempt to designate trauma centers in all areas of the state and ensure that at least one Level I trauma center serves each Emergency Medical Services region, unless waived by the Department. 515 Ill. Adm. Code 2000(a).
Illinois statute also confers on the Illinois Department of Health the authority and responsibility to establish the minimum standards for designation as a Level I or Level II trauma center. 210 ILCS 50/3.90(b)(1). The designation criteria for Level I and II trauma centers are specified in 515 Ill. Adm. Code 2030 and 515 Ill. Adm. Code 2040 respectively.
Iowa:
Iowa statute confers on the Iowa Department of Public Health the responsibility to adopt rules which specify hospital and emergency care facility verification criteria as well as the verification process. Iowa Code § 147A.23(2)b. Level I and II trauma care facilities must be verified by the ACS Committee on Trauma. 641 IAC 134.2(6)(a). Level III and IV trauma care facilities must be verified by the Iowa Department of Public Health in consultation with the trauma survey team. 641 IAC 134.2(6)(d). Iowa’s level III and IV verification are the criteria from the Resources for the Optimal Care of the Injured Patient 2014, adopted by reference into Iowa Administrative Code. 641 IAC 134.2(3).
Michigan:
Michigan Public Health Code 333.20910(1) confers on the Department of Health and Human Services the responsibility to develop, implement and promulgate rules for the implementation and operation of a statewide trauma care system and to develop a statewide process for verification and designation of trauma facilities. Health care facilities seeking designation as a Level I or II trauma care facility must be verified by the ACS Committee on Trauma and comply with the additional requirements specified by the Michigan Department of Health and Human Services regarding data submission requirements, participation in regional injury prevention plans and regional performance improvement processes and providing assistance to the Department of Health and Human Services in the designation and verification process of other facilities. Mich. Admin. Code R 325.130(6).
Health care facilities seeking designation as a Level III trauma care facility may either be verified by the ACS Committee on Trauma or by the Department of Health and Human Services. Mich Admin. Code R 325.130(7). All Level III facilities, regardless of verification method, must comply with additional data submission requirements and participate in regional injury prevention plans and performance improvement processes. Health care facilities seeking designation as a Level IV trauma care facility must be verified by the Department of Health and Human Services. Mich. Admin. Code R 325.130(8). These facilities must comply with additional data submission requirements and participate in regional injury prevention plans and performance improvement processes. Mich. Admin. Code R 325.130(8).
Minnesota:
Minnesota Statue 144.603(1) (2017) confers on the Commissioner of the Department of Health the responsibility to adopt criteria to ensure that severely injured people are promptly transported and treated at trauma hospitals appropriate to the severity of injury. These criteria must be based on Minnesota’s comprehensive statewide trauma system plan with the advice of the Trauma Advisory Council and using accepted standards from the ACS, the American College of Emergency Physicians, the Minnesota Emergency Medical Services Regulatory Board, the national Trauma Center Association of America and other trauma experts. Minn. Stat. 144.603(2) (2017).
Facilities seeking designation as a Level I or II trauma care facility must be verified by the ACS. Minn. Stat. 144.605(3) (2017). Facilities seeking designation as a Level III trauma care facility may either be verified by the ACS or by the Department of Health using the criteria adopted by the Commissioner. Minn. Stat. 144.605(4) (2017). Facilities seeking designation as a Level IV trauma care facility must be verified by the Department of Health using the criteria adopted by the Commissioner. Minn. Stat. 144.605(4) (2017).
Summary of factual data and analytical methodologies
The department relied on the following sources to draft the proposed rule:
A.
Resources for the Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons (1998). This publication is on file in the Department’s Division of Public Health.B.
Resources for the Optimal Care of the Injured Patient: 2006, Committee on Trauma, American College of Surgeons (2006). This publication is on file in the Department’s Division of Public Health.
