Montana Administrative Register Notice 37-754 No. 11   06/03/2016    
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In the matter of the amendment of ARM 37.104.3006, 37.104.3007, 37.104.3014, and 37.104.3020,  pertaining to trauma care councils and registry







TO: All Concerned Persons


          1. On June 23, 2016, at 9:00 a.m., the Department of Public Health and Human Services will hold a public hearing in Room 207 of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.


2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact the Department of Public Health and Human Services no later than 5:00 p.m. on June 15, 2016, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:



(1) remains the same.

          (2) Each Regional Trauma Care Committee must have, as a minimum, a subcommittee structure that addresses each of the following elements:

          (a) through (4) remain the same.


AUTH:  50-6-402, MCA

IMP:  50-6-402, 50-6-412, 50-6-415, MCA


          37.104.3007 STATE TRAUMA CARE COMMITTEE (1) remains the same.

          (2) The Trauma Care Committee must, at a minimum, have a subcommittee structure that addresses each of the following:

          (a) through (5) remains the same.


AUTH:  50-6-402, MCA

IMP:  50-6-402, 50-6-415, MCA


          37.104.3014 TRAUMA REGISTRIES AND DATA REPORTING (1) remains the same.

          (2) Within 60 days after the end of each quarter, each health care facility that provides service or care to trauma patients within Montana must submit to the department the information required by (4) concerning any trauma patient that it serves during any month of the quarter and who meets the criteria for inclusion in the trauma register that are set forth in Appendix J of the State Trauma Plan.

          (3) The data must be submitted to the department's trauma register in the same format as the state register uses, unless the department allows an alternate means of submission if use of the department's prescribed format would impose a severe hardship on the reporting facility. Regional trauma centers and area trauma hospitals must submit the data electronically, and community trauma facilities, trauma receiving facilities and all other health care facilities treating trauma patients must submit the data using a paper format. All health care facilities must submit the data electronically.

          (4) and (5) remain the same.


AUTH: 50-6-402, MCA

IMP: 50-6-401, 50-6-402, MCA


          37.104.3020 COMPOSITION OF SITE REVIEW TEAMS (1) The site review team for regional trauma centers must be composed of out-of-state surveyors, including a two general surgeons and a trauma nurse coordinator, as well as department staff and or any other members determined to be necessary by the department or requested by the health care facility being reviewed.

          (2) and (3) remain the same.


AUTH:  50-6-402, MCA

IMP:  50-6-402, MCA




The Department of Public Health and Human Services (department) is proposing to amend ARM 37.104.3006, 37.104.3007, 37.104.3014, and 37.104.3020 to update the rules to reflect current routines and practices.


Since their original adoption in 2006, the rules have not been altered or updated. In the ten years since its adoption into rule, the State Trauma Care Committee (STCC) and Regional Trauma Care Committees (RTACs) have matured and developed into well-established work groups that function smoothly in their existing format. Current administrative rules mandate a structure that is not ideal for the committees to address topics that affect trauma across the state and needs to be altered to reflect how the committees are actually performing and meeting the duties accurately. In addition to the committees, the composition of designation site-review teams also necessitates an update to modify the reviewer's level(s) of proficiency to perform the reviews at the various levels of trauma centers. And finally, as technology has advanced significantly in the past decade, the trauma registry has moved from a paper format to an electronic format and these administrative rules are being amended to reflect that change.


The STCC has been reviewing and recommending language changes since 2015 when it recognized the need for updates.  STCC is comprised of members of various medical groups across the state:  Montana Trauma Coordinators; Central Regional Trauma Advisory Committee (RTAC); Eastern RTAC; Montana Committee on Trauma/American College of Surgeons (ACS); Montana Medical Association; Montana Hospital Association; Montana Emergency Nurses Association; Montana Emergency Medical Services (EMS) Association; Indian Health Service; Western RTAC; Private Ambulance Operators; and American College of Emergency Physicians.


The committee has reviewed each proposed rule amendment, fully discussed and scrutinized the proposed changes, and only then recommended approval for the changes to move forward to public rules.


ARM 37.104.3006 and 37.104.3007


The department proposes to amend these rules by changing the reference to the subcommittee structure that addresses the minimum of five different elements. Currently, these elements are addressed at each meeting in the general session, not in individual subcommittees. If these rules are not amended, they will not reflect current routines and practices that presently allow the committees to meet all mandatory requirements in a format that is suitable and straightforward.  Mandating a strict, rigid structure that does not allow the committees to function in a way that meets their needs, while still conducting all necessary business, does not make good sense.


ARM 37.104.3014


The department proposes to amend this rule by changing where it refers to "Appendix J" to the title "State Trauma Plan." Also, the department proposes to change the reference to data submission in a paper format to submission electronically for all healthcare facilities to comply with current technological demands. Not updating and allowing for submission of trauma registry data electronically does not keep current with modern technology and provide ease of submission of the mandatory data into the central registry where it is amassed.


Adjusting the rules to confirm that the right surveyor with the appropriate experience and expertise can review the right level of facility is very important to ensure high quality trauma services are being provided across the state.


ARM 37.104.3020


The department proposes to amend this rule by changing the requirement for regional trauma centers from one general surgeon and one nurse coordinator to two general surgeons.  Also, the department proposes to remove the requirement of surveyors for area and community trauma hospitals to only come from a trauma region other than the one the facility is in. This is necessary because adjusting the administrative rules to confirm that the right surveyor with the appropriate experience and expertise can review the right level of facility is very important to ensure high quality trauma services are being provided across the state.


Fiscal Impact


There is no fiscal impact with these proposed administrative rule amendments.


          5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., July 1, 2016.


6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.


7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.


8. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.


9. The bill sponsor contact requirements of 2-4-302, MCA, do not apply.


10. With regard to the requirements of 2-4-111, MCA, the department has determined that the amendment of the above-referenced rules will not significantly and directly impact small businesses.


11. Section 53-6-196, MCA, requires that the department, when adopting by rule proposed changes in the delivery of services funded with Medicaid monies, make a determination of whether the principal reasons and rationale for the rule can be assessed by performance-based measures and, if the requirement is applicable, the method of such measurement. The statute provides that the requirement is not applicable if the rule is for the implementation of rate increases or of federal law.


The department has determined that the proposed program changes presented in this notice are not appropriate for performance-based measurement and therefore are not subject to the performance-based measures requirement of 53-6-196, MCA.



/s/ Nicholas Domitrovich                        /s/ Richard H. Opper                            

Nicholas Domitrovich, Attorney             Richard H. Opper, Director

Rule Reviewer                                       Public Health and Human Services



Certified to the Secretary of State May 23, 2016.


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