F. Children with terminal illness
§ 3.2 Criteria.
A. The child must require at a minimum:
1. Physician visits at least once weekly (the
initial physician visit must be made by the physician personally. Subsequent
required physician visits after the initial visit may alternate between
personal visits by the physician and visits by a physician assistant or nurse
practitioner.)
2. Skilled nursing
services 24 hours a day (a registered nurse must be on the nursing unit on
which the child is residing, 24 hours a day, whose sole responsibility is that
nursing unit)
3. Coordinated
multidisciplinary team approach to meet needs
4. The nursing facility must coordinate with
appropriate state and local agencies for the educational and habilitative needs
of the child. These services must be age appropriate and appropriate to the
cognitive level of the child. Services must also be individualized to meet the
specific needs of the child and must be provided in an organized and proactive
manner. Services may include but are not limited to school, active treatment
for mental retardation, habilitative therapies, social skills and leisure
activities. The services must be provided for a total of 2 hours per day,
minimum.
B. In addition,
the child must meet one of the following requirements:
1. Must require two out of three of the
following rehabilitative services: Physical Therapy, Occupational Therapy,
Speech-pathology services; therapy must be provided at a minimum of 6 therapy
sessions (minimum of 15 minutes per session) per day, 5 days per week; child
must demonstrate progress in overall rehabilitative plan of care on a monthly
basis; or
2. Must require special
equipment such as mechanical ventilators, respiratory therapy equipment (that
has to be supervised by licensed nurse or respiratory therapist), monitoring
device (respiratory or cardiac) kinetic therapy, etc., or
3. Children that require at least one of the
following special services:
a. Ongoing
administration of intravenous medications of nutrition (i.e., TPN, antibiotic
therapy, narcotic administration, etc.)
b. Special infection control precautions
(universal or respiratory precaution; this does not include handwashing
precautions only or isolation for normal childhood diseases such as measles,
chicken pox, strep throat, etc.)
c.
Dialysis treatment that is provided within the facility (i.e., peritoneal
dialysis)
d. Daily respiratory
therapy treatments that must be provided by a skilled nurse or respiratory
therapist
e. Extensive wound care
requiring debridement, irrigation, packing, etc., more than two times a day
(i.e., grade IV decubiti; large surgical wounds that cannot be closed, second
or third degree burns covering more than 10% of the body)
f. Ostomy care requiring services by a
licensed nurse
g. Care for terminal
illness
