HD30 - Medicaid Study of Services for Multiple Trauma Patients

  • Published: 1988
  • Author: Department of Medical Assistance Services
  • Enabling Authority: House Joint Resolution 331 (Regular Session, 1987)

Executive Summary:
Legislative action by the 1987 General Assembly requested the Department of Medical Assistance Services to evaluate Title XIX of the Social Security Act as amended and the Virginia State Plan for Medical Assistance Services to ascertain whether there were any services or reimbursement levels which could be revised to provide more adequate services to multiple trauma patients.

Virginia's Medicaid program currently provides the multiple trauma victim coverage for transport from the scene of the trauma as well as transport between institutions as dictated by medical needs. In addition, payment for hospitalization is covered for all days medically indicated for persons under age 21, and for those age 21 and over with the limitation of 21 days coverage in a 60 day period per admission for the same or similar diagnosis.

Results from a survey of Level I trauma centers indicate that victims' lengths of stay in a trauma service unit vary from 6.84 to 14 days, with an average of 10.8 days. A review of Medicaid data indicates that approximately 97% of all medically indicated days of hospitalization are covered.

Subsequent to the acute phase of hospitalization, intensive rehabilitation days provided in certified rehabilitation facilities are covered by Medicaid as medically indicated for multiple trauma victims regardless of age. Also covered are transportation to the rehabilitation facility, nursing care (both intermediate and skilled care), home health services, and personal care services in a community setting.

Durable medical equipment and supplies are not covered by Medicaid except when a recipient is under a home health plan of care.

A survey of contiguous states indicates that the Virginia Department of Medical Assistance Services is providing payment for as broad a range of services to multiple trauma victims as any adjoining state.

Based on available information and data, it is concluded that there are two potential revisions to the State Plan which would increase services to multiple trauma victims. These are an increase in the number of inpatient acute care hospital days covered and an extension of coverage for durable medical equipment and supplies. This report recommends that funding be provided for increased coverage of medically necessary hospital days and durable medical equipment and supplies to all eligible Medicaid recipients.