LAC 48:I.5237. Acceptance Criteria

A. Each PDHC facility shall have written policies and procedures governing the acceptance and participation of children in their pediatric day health care program. B. Infants or children shall be considered for acceptance to the facility if they have been diagnosed with a medically complex condition(s) which is characterized by multiple significant medical problems that require extended care (i.e., medically fragile). 1. For purposes of these provisions, medically fragile conditions include, but are not limited to: a. severe lung disease requiring oxygen; b. severe lung disease requiring ventilator or tracheotomy care; c. complicated spina bifida; d. heart disease; e. malignancy; f. asthmatic exacerbations; g. cystic fibrosis exacerbations; h. neuromuscular disease; i. encephalopathy; and j. seizure disorders. C. The child shall be stable for outpatient medical services and require ongoing nursing care and other interventions. Children with risk of infectious disease or acute infection shall be accepted only as authorized by the prescribing physician in collaboration with the PDHC facility medical director. D. The prescribing physician, in consultation with the parent(s), shall recommend participation in a pediatric day health care program, taking into consideration the medical, emotional, psychosocial and environmental factors. 1. No child shall be accepted to participate in PDHC facility services without a prescription from the child’s prescribing physician. 2. The medical director of the PDHC facility may provide the referral to the facility only if he/she is the child’s prescribing physician, and only if the medical director has no ownership interest in the PDHC facility. 3. No member of the board of directors of the PDHC facility may provide a referral to the PDHC. No member of the board of directors of the PDHC facility may sign a prescription as the prescribing physician for a child to participate in the PDHC facility services. 4. No physician with ownership interest in the PDHC may provide a referral to the PDHC. No physician with ownership interest in the PDHC may sign a prescription as the prescribing physician for a child to participate in the PDHC facility services. 5. Notwithstanding anything to the contrary, providers are expected to comply with all applicable federal and state rules and regulations including those regarding anti-referral and the Stark Law. E. A consent form, outlining the purpose of the facility, parent’s responsibilities, authorized treatment and emergency disposition plans shall be signed by the parent(s) and witnessed prior to acceptance into the facility’s PDHC program. The parent(s) shall be provided a copy of the consent form and the facility shall retain a copy in their records. F. Before care is initiated, the PDHC facility shall inform the parent orally and in writing of: a. those charges for services that will not be covered by the child’s payor source; and b. the charges that the parent may be responsible for paying. G. Conference Prior to Attendance. If the child meets the criteria for acceptance into a PDHC facility program, the prescribing physician or his/her designee shall contact the medical or nursing director of the PDHC facility to schedule a conference prior to the child attending the facility. 1. If the child is hospitalized at the time of referral, planning for PDHC participation shall include the parent(s), relevant hospital medical, nursing, social services and developmental staff to begin development of the plan of care that will be implemented following acceptance to the PDHC facility. 2. If the child is not hospitalized at the time of referral, planning for PDHC participation shall be conducted with the prescribing physician, parent(s), PDHC facility representative(s), and representative(s) of other relevant agencies to begin development of the plan of care that will be implemented following acceptance to the PDHC facility.