Current through Register Vol. 48, No. 12, March 22, 2024
a) The facility shall establish admission
criteria for respite care that provide for:
1)
The admission of children for no more than 14 days, unless an extended
authorization is approved by the Division of Specialized Care for Children for
a family emergency such as, but not limited to, a funeral, the primary
caregiver recovering from a medical event, or if more time is needed for
respite services;
2) The admission
of children whose medical plan of care can be met by the facility;
and
3) Nondiscrimination toward
children or their families based on disability, race, religion, sex, source of
payment, and any other basis recognized by applicable State and federal
laws.
b) Eligibility for
Respite Care Admissions
1) The child (under
age 22) shall be medically complex, may be technology dependent, or shall have
a medical condition that requires care to be delivered by a nurse or trained
parent/caregiver.
2) The facility's
site physician or site APRN shall review the child's clinical documentation
prior to admission. Documentation shall consist of a physician's signed medical
plan of care from private duty nursing where applicable, or documentation
provided by a caregiver such as a primary care physician, an APRN, or
specialist. The site APRN will confirm the information on the day of the
child's admission and enter it in an electronic medical record, and obtain and
review any other documentation necessary to provide safety and comfort in the
facility environment.
3) The
medical plan of care provided by the health care provider and reviewed by the
facility's medical director shall include, but not be limited to, the
following:
A) Diagnosis;
B) Food or drug allergies;
C) Prescription medications;
D) Other medications, including holistic or
over-the-counter;
E) Scheduled
treatments or therapies;
F) Feeding
and nutritional guidelines;
G)
Vital sign and transfer parameters;
H) Equipment and monitoring
parameters;
I) Current
vaccines;
J) Any additional
information that will help the child's stay, such as individual child's
preferences or habits to assist in the child's care; and
K) Any activity restrictions.
4) The facility shall employ
Registered Nurses who are trained in cardio-pulmonary resuscitation (CPR), are
certified in Pediatric Advanced Life Support, and who have additional training
on equipment specific to the child, such as ventilator equipment.
5) Prior to a child's admission for respite
care, the facility shall conduct an assessment of the child, review the home
care plan with the child's representative, and develop a medical plan of care
to meet the needs of the child. The facility shall obtain the information that
forms the basis for the medical plan of care from the child's representative.
That information shall include, but not be limited to:
A) A description of the child's usual
routine;
B) Instructions for the
child's personal care;
C) Food
preferences and feeding schedule;
D) Food, drug or other allergies;
E) Scheduled treatments or
therapies;
F) Vaccines and
immunizations;
G) Educational or
therapy programming;
H) Emergency
contact information; and
I) Any
additional information, such as the child's preferences or habits, that will
assist in the child's care.
c) The facility shall establish admission
criteria for transitional care that provide for:
1) The admission of children for no more than
120 days;
2) The admission of
children whose medical plan of care can be met by the facility; and
3) Nondiscrimination toward children or their
families based on disability, race, religion, sex, source of payment, and any
other basis recognized by applicable State and federal laws.
d) Eligibility Criteria for
Transitional Care Admissions
1) The child
(under age 22) shall be medically complex, may be technology dependent, or
shall have a medical condition that requires care to be delivered by a nurse or
trained parent/caregiver.
2) The
facility shall employ Registered Nurses who are current in CPR and are
certified in Pediatric Advanced Life Support, and who have additional training
on equipment specific to the child, such as ventilator equipment.
3) There shall be an identified child's
representative and a plan in place to secure a safe residence upon discharge
from transitional care.
4) If the
child doesn't have an identified primary health care provider, the site
physician will act as the primary health care provider until a primary health
care provider is identified.
5) The
facility's medical director shall review the child's clinical documentation
prior to admission. Documentation shall include, but not be limited to, a
medical plan of care, hospital health care provider progress notes, medical
history and a physical examination, and any other documentation that would
assist the facility in caring for the child.
6) A child being referred from an acute care
or intermediate care hospital shall have a complete onsite preadmission
assessment by the facility's case manager and may include the site APRN as
needed before admission is approved.
7) The child's diagnosis or history shall not
include behaviors that would interfere with the safety of the child or others,
or that would prevent the child from being safely cared for in the physical and
medical environment provided.
8)
The child shall be clinically stable.
9) A child with a new tracheostomy shall be
stable and shall have the first tracheostomy change done in the hospital
setting prior to transfer.
10) A
child transferring from a newborn intensive care unit (NICU) shall be stable on
a home ventilator for at least three weeks with no significant setting changes
(e.g., breath rate, pressure changes, mode, oxygen requirements, a change in
the amount of time on a ventilator).
11) For a child's initial transfer from a
pediatric intensive care unit (PICU), the child shall be stable on a home
ventilator for one week with no significant changes (e.g., breath rate,
pressure changes, mode, oxygen requirements, a change in the amount of time on
a ventilator).
12) If, at the time
of admission, a child currently is being treated for a bacterial infection, the
child shall have been on antibiotics and afebrile for 48 hours prior to
admission.
13) The child shall
tolerate feedings or have an alternative means of nutrition.
14) Vaccines and immunizations shall be
current, or the facility shall ensure that the child has a catch-up
immunization plan.
15) Durable
medical equipment company supplies shall be functional. Equipment and supplies
shall be present 24 hours prior to admission, unless the child's equipment is
transferring with the child from the hospital.
16) Identified child's representative shall
sign or have signed a training agreement within 24 hours after
admission.
e) The child
shall be ineligible for admission if the child requires any of the following:
1) Continuous 1:1 direct, visual nursing
supervision or care;
2) Scheduled
nebulizer treatment more frequently than every two hours;
3) Except for children in hospice care,
scheduled supplemental oxygen greater than 40% FiO2;
4) Hyperalimentation requiring daily
adjustments;
5) Endotracheal
intubation; or
6) Pressor
medications requiring monitored adjustments.
f) Within the first eight hours after
admission, the child shall undergo a complete nursing assessment, and a nursing
narrative shall be completed.
g)
The facility shall admit and serve only those children for whom it has the
trained personnel, equipment and supplies to meet the medical plan of care and
to ensure the safety of the child.
h) A site physician shall be identified for
each child admitted. The medical plan of care shall document the method for
contacting the site physician at any time.
i) The facility shall ensure that all of a
child's home medical equipment is managed by an identified durable medical
equipment company who shall provide proof of service.
j) The facility shall establish participation
criteria for medical day care that provide for:
1) The participation of children for no more
than 12 hours in 24 hours;
2) The
participation of children whose plans of treatment can be met by the
facility;
3) Nondiscrimination
toward children or their families based on disability, race, religion, sex,
source of payment, and any other basis recognized by applicable State and
federal laws; and
4) A staff for
the medical day care that is separate and distinct from the staff that provides
services for children receiving respite care or transitional care.
k) The facility shall establish
participation criteria for weekend camps that provide for:
1) The participation of children whose plans
of treatment can be met by the facility;
2) Nondiscrimination toward children or their
families based on disability, race, religion, sex, source of payment, and any
other basis recognized by applicable State and federal laws; and
3) A staff for the weekend camps that is
separate and distinct from the staff that provides services for children
receiving respite care or transitional care.
l) The facility shall establish criteria for
diagnostic studies that provide for:
1)
Conducting only those diagnostic studies ordered by a physician and that are
typically conducted in the home;
2)
Meeting all provisions for short-term stays, in accordance with subsection (a),
if children are admitted overnight;
3) The participation of children whose plans
of treatment can be met by the facility; and
4) Nondiscrimination toward children or their
families based on disability, race, religion, sex, source of payment, and any
other basis recognized by applicable State and federal laws.