(a) To qualify for
subacute level of care under group I, patients, age twenty-one years and older,
must be medically stable and require continuous mechanical ventilation for at
least fifty per cent of each day.
(b) To qualify for subacute level of care
under group II, non-ventilator patients, age twenty-one years and older, who
require a higher level of service than SNF, but who do not require acute
hospital care, must be medically stable and require the following services:
(1) Tracheostomy care with suctioning
required at least once an hour;
(2)
Any combination of mechanical ventilation, tracheostomy care with suctioning
and inhalation treatment with or without oxygen at least once a
shift;
(3) Total parenteral
nutrition;
(4) Continuous
intravenous therapy for the administration of therapeutic agents or hydration,
or intermittent IV therapy for the administration of therapeutic drugs at least
once a shift through a peripheral or central line or both. Therapeutic agents
are to include antibiotics, non-vescicant oncology chemotherapy, and
analgesics;
(5) Stable newborns or
premature infants under age one, who have been inpatients in the acute hospital
for at least a week and cannot be discharged because they require any of the
following services:
(A) Monitoring episodes
of bradycardia and apnea which are resolved by manual stimulation in infants
for whom discharge from a facility is medically inappropriate; or
(B) Nasogastric tube or gastrostomy
feedings;
(6) Stable
patients admitted to the acute care hospital for infections, who are afebrile
for twenty-four hours on intravenous or parenteral antibiotics and undergoing
twenty-four to forty-eight hour trials of oral antibiotics or being trained to
infuse parenteral antibiotics in the home in preparation for discharge to the
home;
(7) Two or more of the
following services:
(A) Tracheostomy care
with suctioning required at least once a shift;
(B) Traction and pin care for fractures
(Bucks Traction is not included);
(C) Medically necessary isolation precautions
as recommended by the Centers for Disease Control. (Infection control measures
for the care of decubitus ulcers do not apply in this category);
(D) Debridement, packing, and medicated
irrigation with or without whirlpool treatment, aseptic dressing changes,
management of extensive (stage III) decubitus ulcers or wound infection, and JP
drains;
(E) Skilled nursing
services including but not limited to the monitoring, observation, and care of
patients with HIV infection/AIDS, patients who have terminal diseases, patients
who require chronic dialysis treatment, patients receiving radiation therapy,
patients receiving treatment for dehydration or monitoring of hydration, or
patients receiving treatment for pain control who have or are at high risk for
significant medical complications;
(F) Skilled nursing care including
observation, monitoring for the side effects of treatment for patients
receiving radiation therapy, or the monitoring of hydration and pain control
who have or are at high risk for significant medical complications;
(G) At least daily ventilation or inhalation
therapy services or both with or without oxygen;
(H) Treatment of patients with eating
disorders including bulimia and anorexia nervosa who require skilled
supervision and monitoring of food intake and psychiatric inpatient care and
are medically stable in the inpatient facility, but who are at high risk of
medical complications if discharged to outpatient care; or
(H) Treatment of psychiatric patients who are
not an immediate danger to themselves or others, but who require inpatient
monitoring, supervision, and psychiatric care because of high risk for
life-threatening complications to themselves or others if discharged to
outpatient care; or
(c) Group III pediatric patients who no
longer require inpatient acute care, must be at baseline status, and not at
risk for rapid deterioration. Requires dynamic care meeting the following:
(1) Weekly medical interventions and
monitoring; and
(2) Twenty-four
hours a day skilled nursing;
(3)
Types of interventions required in group III pediatric subacute level of care
are:
(A) Pediatric patients who are
ventilator dependent;
(B)
Tracheostomy care with skilled interventions (e.g. suctioning greater than once
in an eight hour shift.
(d) Group IV pediatric patients who no longer
requires acute care, must be at baseline state and not at risk for rapid
deterioration. Requires chronic care meeting the following:
(1) Medical interventions and monitoring at
least weekly; and
(2) Skilled
nursing intervention at least once per shift.
(3) Types of interventions required in group
IV pediatric subacute level of care are:
(A)
Continuous intravenous therapy for administration of therapeutic agents or
hydration, or intermittent IV therapy for the administration of therapeutic
drugs at least once a shift through a peripheral of central line (antibiotics,
nonvesican oncology chemotherapy, and analgesics, TPN).
(B) Two or more of the following services:
(i) Tracheostomy care with suctioning not
more than once in an eight hour shift and does not require continuous
monitoring;
(ii) Debridement,
packing, and medicated irrigation, aseptic dressing changes, extensive care of
decubiti (stage III), or wound infection and drains.
(iii) Skilled supervision and monitoring of
nutritionally compromised patients with eating disorders at high risk of
medical complications if managed in an outpatient setting;
(iv) At least daily inhalation therapy by
skilled staff; or
(v) Multiple (two
or more modalities) rehabilitative services required daily with short and long
term attainable goals.
(e) Admission to the subacute level for
individuals who require other services shall be made on a case-by-case
basis.