DHS 118.04(6)(a)5.a.a. Except as provided under subd. 5. b., within 60 business days of receiving a complete application for department approval to be a trauma care facility, the department shall either approve or deny the application and notify the applicant hospital in writing. In this subdivision paragraph, “complete application” means a completed application form and the documentation necessary to establish that the hospital is a level I, II, III or IV trauma care facility.
DHS 118.04(6)(a)5.b.b. If the department determines a need to conduct a site visit of the applicant hospital, the department shall notify the applicant hospital of its level of trauma care within 10 business days following the department’s receipt of the site visit findings under subd. 4. c.
DHS 118.04(6)(a)5.c.c. If the department does not approve the applicant hospital’s application, the department shall give the applicant reasons, in writing, for the denial and shall inform the applicant of the right to appeal the department’s decision under sub. (7).
DHS 118.04(6)(a)5.d.d. In the absence of other evidence of receipt, receipt of the department’s notice under this subdivision is presumed on the 5th day following the date the department mails the notice.
DHS 118.04(6)(a)6.6. If the department determines the applicant hospital’s trauma care capabilities do not warrant the hospital being approved as a trauma care facility, the department shall consider the hospital to be an unclassified hospital.
DHS 118.04(6)(b)(b) Department review of and decision on a hospital’s selection of an RTAC for primary membership.
DHS 118.04(6)(b)1.1. The department shall review each hospital selection of an RTAC for primary membership pursuant to s. DHS 118.08 (1) (a) 2.
DHS 118.04(6)(b)2.2. If the department does not notify the hospital of its approval or disapproval within 30 calendar days of receiving a hospital RTAC selection for department approval, the hospital may consider their selection approved by the department.
DHS 118.04(6)(b)3.3. If the department does not approve the hospital’s selection of an RTAC, the department shall give the applicant reasons, in writing, for the denial and shall inform the applicant of the right to appeal the department’s decision under sub. (7).
DHS 118.04(6)(b)4.4. In the absence of other evidence of receipt, receipt of the department’s notice under this subdivision is presumed on the 5th day following the date the department mails the notice.
DHS 118.04(6)(c)(c) Department review of and decision on RTAC applications, selections, needs assessments, triage and transport protocols and plans.
DHS 118.04(6)(c)1.1. An RTAC requesting department approval of any of the following shall submit it to the department:
DHS 118.04(6)(c)1.a.a. An application under s. DHS 118.06 (3) (a).
DHS 118.04(6)(c)1.b.b. A selection of an executive council, coordinating facility, fiscal agent and resource hospital under s. DHS 118.06 (3) (c), (d), (e) and (f).
DHS 118.04(6)(c)1.c.c. A needs assessment of its trauma region under s. DHS 118.06 (3) (L), and a triage and transport protocol or plan under s. DHS 118.06 (3) (o).
DHS 118.04(6)(c)2.2. The department shall review each RTAC submission made under subd. 1.
DHS 118.04(6)(c)3.a.a. Within 90 business days of receiving an RTAC submission under subd. 1., the department shall either approve or deny the RTAC submission and notify the RTAC in writing.
DHS 118.04(6)(c)3.b.b. If the department does not approve an RTAC’s submission, the department shall give the RTAC reasons, in writing, for the denial. The department shall also inform the applicant of the right to appeal the department’s decision under sub. (7).
DHS 118.04(6)(c)3.c.c. In the absence of other evidence of receipt, receipt of the department’s notice under this subdivision is presumed on the 5th day following the date the department mails the notice.
DHS 118.04(6)(c)4.4. In response to the department’s non-approval under subd. 3., the RTAC may modify its submission and submit the revision to the department for subsequent department review or appeal the department’s decision pursuant to sub. (7).
DHS 118.04(6)(d)(d) Department withdrawal of RTAC approval.
DHS 118.04(6)(d)1.1. The department may withdraw its approval of an RTAC’s operations if the department makes a finding of any of the following:
DHS 118.04(6)(d)1.a.a. The RTAC does not meet the eligibility requirements established in s. 256.15, Stats., and this chapter.
DHS 118.04(6)(d)1.b.b. The department approval was obtained through error or fraud.
DHS 118.04(6)(d)1.c.c. The RTAC violated any provision or timeline of s. 256.15, Stats., or this chapter.
DHS 118.04(6)(d)2.2. The department shall send written notice of the department’s proposed action and of the right to request a hearing under sub. (7) to the RTAC within 48 hours after the withdrawal takes place. In the absence of other evidence of receipt, receipt of the department’s notice is presumed on the 5th day following the date the department mails the notice.
DHS 118.04(7)(7)Appeals of department decisions.
DHS 118.04(7)(a)(a) If under sub. (6), the department does not approve a hospital’s application under sub. (6) (a) or selection under sub. (6) (b), or an RTAC’s submission under sub. (6) (c) or the department withdraws its approval of an RTAC under sub. (6) (d), the hospital or RTAC may request a hearing under s. 227.42, Stats. The request for a hearing shall be submitted in writing to and received by the department of administration’s division of hearings and appeals within 30 days after the date of the notice required under sub. (6). A request is considered filed when received by the division of hearings and appeals.
DHS 118.04(7)(b)(b) The division of hearings and appeals shall hold the hearing no later than 30 days after receiving the request for the hearing unless both parties agree to a later date and shall provide at least 10 days prior notification of the date, time and place for the hearing.
DHS 118.04(7)(c)(c) The hearing examiner shall issue a proposed or final decision within 30 days after the hearing. The department decision shall remain in effect until a final decision is rendered.
DHS 118.04 NoteNote: A hearing request should be addressed to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707. Hearing requests may be delivered in person to that office at 5005 University Ave., Room 201, Madison, WI or submitted by facsimile to 608-264-9885.
DHS 118.04 HistoryHistory: CR 04-055: cr. Register December 2004 No. 588, eff. 1-1-05; corrections in (6) (d) 1. a. and c. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; CR 19-086: am. (2) (c) 2. Register May 2021 No. 785, eff. 10-1-21.
DHS 118.05DHS 118.05Statewide trauma advisory council. The statewide trauma advisory council shall be responsible for all of the following:
DHS 118.05(1)(1)Advising the department on issues related to the development, implementation and evaluation of the statewide trauma care system.
DHS 118.05(2)(2)Reviewing and approving the department’s proposed format and content of RTAC trauma plans.
DHS 118.05(3)(3)Reviewing and recommending components of the department’s trauma data submission manual under s. DHS 118.09 (2) (a) and the use of trauma registry data under s. DHS 118.09 (4) (a).
DHS 118.05 HistoryHistory: CR 04-055: cr. Register December 2004 No. 588, eff. 1-1-05.
DHS 118.06DHS 118.06Regional trauma advisory councils.
DHS 118.06(1)(1)Purpose. The purpose of a regional trauma advisory council is to develop, implement, monitor and improve the regional trauma system.
DHS 118.06(2)(2)Participation in RTAC activities. A regional trauma advisory council may include facilities or organizations located in a neighboring state that provide trauma care to Wisconsin residents.
DHS 118.06(3)(3)Regional trauma advisory council responsibilities. A regional trauma advisory council shall do all of the following:
DHS 118.06(3)(a)(a) Submit an application to the department for approval as an RTAC pursuant to s. DHS 118.04 (2) (b) 3.
DHS 118.06 NoteNote: To obtain an application, contact the statewide trauma care coordinator by calling 608-266-0601 or by writing to Statewide Trauma Care System Coordinator, Bureau of Local Public Health Practice and Emergency Medical Services, Room 118, 1 West Wilson St., Madison, WI 53701, or by sending a fax to 608-261-6392.
DHS 118.06(3)(b)1.1. Establish an executive council that has all of the following characteristics:
DHS 118.06(3)(b)1.a.a. Reflects professional representation from out-of-hospital trauma care providers, trauma care facilities, education and injury prevention.
DHS 118.06 NoteNote: Out-of-hospital trauma care providers include emergency medical services practitioners, emergency medical responders, or air medical personnel.
DHS 118.06(3)(b)1.b.b. May have representation of an out-of-state hospital or ambulance service provider if the hospital or ambulance service provider regularly provides care for persons injured in Wisconsin.
DHS 118.06(3)(b)1.c.c. Includes representation from both urban and rural areas.
DHS 118.06(3)(b)1.d.d. Does not have more than 50 percent of its representation from any single organization. In this subdivision paragraph, “organization” means corporate affiliation, entity or ownership.
DHS 118.06(3)(b)1.e.e. Is responsive to the input of its primary membership and participants.
DHS 118.06(3)(b)1.f.f. Has officers who either live or work in Wisconsin.
DHS 118.06(3)(b)1.g.g. Has representatives who serve only on that single executive council.
DHS 118.06 NoteNote: The Department believes that limiting primary service to the executive council of one RTAC will promote a representative’s focus on and allegiance to that RTAC. Any person, however, may participate in the activities of more than one RTAC.
DHS 118.06(3)(b)2.2. Submit the names and affiliations of council members to the department for review and approval pursuant to s. DHS 118.04 (2) (b) 4.
DHS 118.06(3)(c)1.1. Select a coordinating facility. The coordinating facility shall be or do all of the following:
DHS 118.06(3)(c)1.a.a. Work in collaboration with the department and the regional trauma advisory council to meet the needs required for the development, implementation, maintenance and evaluation of the regional trauma system.
DHS 118.06(3)(c)1.b.b. Except as provided in subd. 1. c. and d., be a Wisconsin-based ACS-verified level I or II trauma facility.
DHS 118.06(3)(c)1.c.c. If a regional trauma advisory council area contains no ACS-verified level I or II trauma facility, the coordinating facility may be an entity that provides written commitment to the department that the entity will become an ACS-verified level I or II trauma facility within 3 years of that assurance.
DHS 118.06(3)(c)1.d.d. If a regional trauma advisory council area contains no ACS-verified level I or II trauma facility, and no entity can provide the department the assurance under subd. 1. c., the coordinating facility may be an entity that assures the department in writing that the entity will obtain the department’s recognition as a level III trauma facility within the time frame specified in the RTAC application.
DHS 118.06(3)(c)1.e.e. Have an ACS-verified level I or II hospital, or an equivalent hospital from an adjoining state, serving as its resource hospital if a level III hospital is serving as the coordinating facility.
DHS 118.06(3)(c)1.f.f. If 2 facilities agree to serve as co-coordinating facilities, one of the facilities shall be an ACS-verified level I or II trauma facility.
DHS 118.06(3)(c)2.2. Submit the name of the facility selected under subd. 1. to the department for review and approval pursuant to s. DHS 118.04 (2) (b) 4.
DHS 118.06(3)(c)3.3. Notify the department and the RTAC executive council at least 30 days before relinquishing the title of coordinating facility if the coordinating facility is unable to fulfill the duties required by the regional trauma advisory council.
DHS 118.06(3)(d)1.1. Select a Wisconsin fiscal agent and submit the name of the fiscal agent to the department for review and approval pursuant to s. DHS 118.04 (2) (b) 4.
DHS 118.06(3)(d)2.2. Ensure that the fiscal agent holds and distributes funds only for the purpose of RTAC activities by not commingling RTAC funds with other funds or using RTAC funds for personal purposes.
DHS 118.06(3)(d)3.3. Ensure that the fiscal agent notifies the department and the executive council at least 30 days before relinquishing the title of fiscal agent if the fiscal agent is unable to fulfill the duties required by the regional trauma advisory council.
DHS 118.06(3)(e)(e) Select a resource hospital and submit the name of the hospital to the department for review and approval pursuant to s. DHS 118.04 (2) (b) 4.
DHS 118.06(3)(f)(f) Transmit all pertinent materials to all regional trauma advisory council members in a timely manner.
DHS 118.06(3)(g)(g) Develop a format for meetings, agendas and minutes, and provide the department with all RTAC meeting times, agendas and minutes.
DHS 118.06(3)(h)(h) Designate a liaison with the department.
DHS 118.06(3)(i)(i) Analyze local and regional trauma registry data collected under s. DHS 118.09.
DHS 118.06(3)(j)(j) Create a local and regional performance improvement process that is consistent with that specified in s. DHS 118.10.
DHS 118.06(3)(k)(k) Develop and implement injury prevention and education strategies based on performance improvement findings.
DHS 118.06(3)(L)1.1. Develop and submit to the department by June 1, 2006, a regional trauma plan based on a needs assessment and with the structure specified by the department.
DHS 118.06(3)(L)2.2. Update the regional trauma plan specified under subd. 1. and submit the plan to the department every 2 years beginning June 1, 2008 following the submittal of the of the initial plan on June 1, 2006.
DHS 118.06(3)(L)3.3. Beginning June 1, 2005, submit a yearly progress report to the department, in the format specified by the department, that contains a description of the progress being made towards achieving the actions specified under the most recent regional trauma plan.
DHS 118.06(3)(m)(m) Resolve conflicts concerning trauma care and injury prevention within the region through a process having the following characteristics:
DHS 118.06(3)(m)1.1. Conflicts needing resolution by the RTAC shall be addressed by the executive council.
DHS 118.06(3)(m)2.2. If the executive council is unable to resolve a contested issue, the executive council chair shall submit the issue to the department for resolution.
DHS 118.06(3)(n)(n) Notify the department within 30 days of any changes in leadership, bylaw revisions or other substantive revisions to the RTAC policies or operations.
DHS 118.06(3)(o)(o) Develop regional triage and transport protocols.
DHS 118.06 HistoryHistory: CR 04-055: cr. Register December 2004 No. 588, eff. 1-1-05.
DHS 118.07DHS 118.07EMS services.
DHS 118.07(1)(1)Responsibility to affiliate with one RTAC.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.