HAR §17-1737-119. Physician services

Physician services shall include, but not be limited to: (1) The evaluation and completion of forms used to establish and continue the subacute level of care for a recipient; (2) Physicians visits at least weekly during the first month and a minimum of once every two weeks thereafter until the stability of the patient's condition allows for monthly visits; (3) A plan of care shall be entered into the medical record and shall include: (A) Medical history, physical findings, and diagnosis indicating the need for admission; UNOFFICIAL 1737-117 (B) A description of the functional level of the patient; (C) Objectives to be achieved by the plan of care; (D) Any orders for medications, treatments, restorative, and rehabilitative services, activities, therapies, social services, therapeutic diet, and special procedures recommended for the health and safety of the patient; (E) Plans for continuing care, including review and modification to the plan of care; (F) Plans for discharge, including responsible family member or care givers; and (G) The attending or staff physician and other personnel involved in the recipients care shall review each plan of care at least every thirty days. [Eff 11/25/96 ] (Auth: §346-14; 42 C.F.R. §431.10) (Imp: HRS§346-14; 42 C.F.R. 431.10, 440.50, 456.60, 456.80, 456.250) §17-1737-120 Subacute patient care characteristics. (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 UNOFFICIAL 1737-118 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 UNOFFICIAL 1737-119 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; (H) At least daily ventilation or inhalation therapy services or both with or without oxygen; (I) 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 (J) 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 UNOFFICIAL 1737-120 (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. [Eff 11/25/96; am 06/19/00 ] (Auth: HRS §346-14; 42 C.F.R. §431.10) (Imp: HRS §346-14)