Section 157.130 - Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Medical Services Account(a) Allocations determination under Texas Health and Safety Code § 773.122 and Health and Safety Code Chapter 780.(1) Department determination. The department determines each year: (A) eligibility criteria for emergency medical services (EMS), trauma service area (TSA), and hospital allocations; and(B) the amount of EMS, TSA, and hospital allocations based on language described in Texas Health and Safety Code § 773.122 and Chapter 780.(2) Eligibility requirements. To be eligible for funding from the accounts, all potential recipients must maintain the regional participation requirements.(3) Extraordinary emergency funding.(A) To be eligible to receive extraordinary emergency funding, an entity must meet the following requirements: (i) be a licensed EMS provider, a designated trauma facility, or a recognized first responder organization (FRO);(ii) submit a completed application and any additional documentation requested by the department; and(iii) provide documentation of active participation in its local Regional Advisory Council (RAC).(B) Incomplete applications will not be considered for extraordinary emergency funding.(4) EMS allocation.(A) The department contracts with each eligible RAC to distribute the county funds to eligible EMS providers based within counties aligned with the relevant TSA. (i) The department evaluates submitted support documents per the contract statement of work. Awarded funds must be used in addition to current operational EMS funding of eligible recipients and must not supplant the operational budget.(ii) Funds are allocated by county to be awarded to eligible providers in each county. Funds are non-transferable to other counties within the RAC if there are no eligible providers in a county.(B) Eligible EMS providers may contribute funds for a specified purpose within the TSA when: (i) all EMS providers received communication regarding the intent of the contributed funds;(ii) the EMS providers voted and approved by majority vote to contribute funds; and(iii) all EMS providers that did not support contributing funds, receive the eligible funding.(C) To be eligible for funding from the EMS allocation, providers must: (i) maintain and comply with all licensure requirements as described in § 157.11 of this chapter (relating to Requirements for an EMS Provider License);(ii) follow RAC regional guidelines regarding patient destination and transport in all TSAs where EMS is provided and verified by each RAC;(iii) notify the RACs of any potential eligibility to receive funds and meet the RACs' participation requirements, if a provider is contracted to provide EMS within a county of any one TSA and whose county of licensure is another county not in or contiguous with that TSA; and(iv) provide the department evidence of a contract or letter of agreement with each additional county government or taxing authority in which EMS is provided in any county beyond its county of licensure.(D) Contracts or letters of agreement must be submitted to the department on or before the stated department contract deadline of the respective year and provide evidence of continued coverage throughout the effective contract dates for which the eligibility of the EMS provider is being considered.(E) EMS providers with contracts or letters of agreement on file with the department meeting the effective contract dates do not need to resubmit a copy of the contract or letter of agreement unless it has expired or will expire before the effective date of the next contract.(F) The submitted contracts or letters of agreement must include effective dates to determine continued eligibility.(G) Inter-facility transfer letters of agreement and contracts or mutual aid letters of agreement and contracts do not meet the requirement of a county contract.(H) EMS providers are responsible for ensuring all contracts or letters of agreement have been received by the department on or before the listed deadline to be considered for eligibility.(I) Air ambulance providers must meet the same requirements as ground transport EMS providers to be eligible to receive funds from a specific county other than the county of licensure.(J) If an EMS provider is licensed in a particular county for a service area considered a geo-political subdivision and whose boundary lines cross multiple county lines, it will be considered eligible for the EMS Allocation for all counties overlapped by that geo-political subdivision's boundary lines. Verification from local jurisdictions will be requested for every county that comprises the geo-political subdivision to determine funding eligibility for each county. The eligibility of EMS providers whose county of licensure is in a geo-political subdivision other than those listed in clauses (i) - (v) of this subparagraph will be evaluated on a case-by-case basis. Geo-political subdivisions include: (iii) emergency service districts (ESDs);(iv) utility districts; or(5) TSA allocation. (A) The department contracts with eligible RACs to distribute the funds for the operation of the 22 TSAs and for equipment, communications, education, and training for the areas.(B) To be eligible to distribute funding on behalf of eligible recipients in each county to the TSA, a RAC must be: (i) officially recognized by the department as described in § 157.123 of this subchapter (relating to Regional Advisory Councils);(ii) in compliance with all RAC performance criteria, have a current RAC self-assessment, and have a current regional trauma and emergency health care system plan; and(iii) incorporated as an entity exempt from federal income tax under Section 501(a), Internal Revenue Code of 1986, and its subsequent amendments by being listed as an exempt organization under Section 501(c)(3).(C) The TSA allocation distributed under this paragraph is based on the relative geographic size and population of each TSA and on the relative amount of trauma care provided.(6) Hospital allocation. The department distributes funds to designated trauma facilities to subsidize a portion of uncompensated trauma care provided or to enhance the facility's delivery of trauma care.(A) Funds distributed from the hospital allocations are made based on: (i) the hospital being designated as a trauma facility by the department as defined in Texas Health and Safety Code Chapter 773;(ii) the percentage of the hospital's uncompensated trauma care cost for patients meeting the National Trauma Data Bank (NTDB) registry inclusion criteria relative to the total uncompensated trauma care cost reported for the identified patient population by qualified facilities that year;(iii) availability of funds; and(iv) submission of a complete application to the department within the stated time frame. Incomplete applications will not be considered.(B) Additional information may be requested by the department to determine eligibility for funding.(C) A designated trauma facility in receipt of funding from the hospital allocation that fails to maintain its designation as required in § 157.125 of this subchapter (relating to Requirements for Trauma Facility Designation Effective Through August 31, 2025) and §157.126 of this subchapter (relating to Trauma Facility Designation Requirements Effective on September 1, 2025), must return to the department all hospital allocation funds received in the prior 12 months within 90 days of failure to maintain trauma designation.(D) The department may grant an exception to subparagraph (C) of this paragraph if it finds compliance with this section would not be in the best interest of the persons served in the affected local system.(E) A facility must have no outstanding balance owed to the department or other state agencies before receiving any future disbursements from the hospital allocation.(7) Department allocations. The department's process for funding allocations defined in this subsection applies to the account defined in Texas Health and Safety Code Chapter 780 and includes designated trauma facilities and those in active pursuit of trauma designation in the funding allocation.(8) Department unawarded designation. An undesignated facility in active pursuit of designation but that has not been awarded a trauma designation by the department pursuant to Texas Health and Safety Code § 780.004 must return to the department all funds received from the hospital allocation, plus a penalty of 10 percent of the awarded amount.(b) Calculation methods. Calculation of county portions of the EMS allocation, the RAC portions of the TSA allocation, and the hospital allocation are: (1) EMS allocation.(A) EMS allocation is derived by adjusting the weight of the statutory criteria to ensure, as closely as possible: (i) 40 percent of the funds go to urban counties; and(ii) 60 percent of the funds go to rural counties.(B) An individual county's portion of the EMS allocation is based on its geographic size, population, and the number of emergency health care runs, multiplied by adjustment factors determined by the department, so the distribution approximates the required percentages for urban and rural counties.(C) The formula is: (i) the county's population multiplied by an adjustment factor;(ii) plus, the county's geographic size multiplied by an adjustment factor;(iii) plus, the county's total emergency health care runs multiplied by an adjustment factor;(v) multiplied by the total EMS allocation.(D) The adjustment factors are manipulated so the distribution approximates the required percentages for urban and rural counties.(E) Total emergency health care runs are the number of emergency patient care records electronically transmitted to the department in a given calendar year by EMS providers.(2) TSA allocation. (A) The TSA allocation is based on its relative geographic size, population, and trauma care provided as compared to all other TSAs.(B) The formula is: (i) the TSA's percentage of the state's total population;(ii) plus, the TSA's percentage of the state's total geographic size;(iii) plus, the TSA's percentage of the state's total trauma care;(v) multiplied by the total TSA allocation.(C) Total trauma care is the number of trauma patient records electronically transmitted to the department in a given calendar year by EMS providers and hospitals.(3) Hospital allocation. (A) Distributions, including unexpended portions of the EMS and TSA allocations, are determined by an annual application process.(B) An annual application must be submitted each state fiscal year. Incomplete applications will not be considered for the hospital allocation calculation.(C) Based on the information provided in the approved application, each facility will receive allocations as follows. (i) An equal amount, not to exceed 20 percent of the available hospital allocation, to reimburse designated trauma facilities and those facilities in active pursuit of designation under the program.(ii) Any funds not allocated in paragraphs (1) and (2) of this subsection are included in the distribution formula in subparagraph (E) of this paragraph.(D) If the total cost of uncompensated trauma care for patients meeting NTDB registry inclusion criteria exceeds the amount appropriated from the account, minus the amount referred to in subparagraph (C)(i) of this paragraph, the department allocates funds based on a facility's percentage of uncompensated trauma care costs in relation to the total uncompensated trauma care cost reported by qualified hospitals for the funding year.(E) The hospital allocation formula for trauma designated facilities is: (i) the facility's reported costs of uncompensated trauma care;(ii) minus any collections received by the facility for any portion of the facility's uncompensated trauma care previously reported for the purposes of this section;(iii) divided by the total reported costs of uncompensated trauma care by eligible facilities; and(iv) multiplied by the total money available after reducing the amount to be distributed in subparagraph (C)(i) of this paragraph.(F) The reporting period of a facility's uncompensated trauma care must apply to costs incurred during the preceding calendar year.(c) Loss of funding eligibility. If the department finds an EMS provider, RAC, or hospital has violated Texas Health and Safety Code Chapter 773 or fails to comply with this chapter, the department may withhold account monies for a period of one to three years, depending upon the seriousness of the infraction.25 Tex. Admin. Code § 157.130
The provisions of this §157.130 adopted to be effective July 29, 2004, 29 TexReg 7103; Amended by Texas Register, Volume 49, Number 46, November 15, 2024, TexReg 9255, eff. 11/24/2024