Section 260.1800 Admission and Participation Practices

Section 260

Section 260.1800  Admission and

Participation Practices

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

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

d,

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

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

all 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

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

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

ment 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.