Cal. Code Regs. Tit. 22, § 51215.11 - Pediatric Subacute Care Unit -Ventilator Weaning
(a) Each pediatric subacute care unit shall
define, implement and maintain a system for assessing, on admission and at
least quarterly, those pediatric patients who are dependent, in part or
completely, on mechanical ventilation for the appropriateness of reduction or
elimination of such dependence.
(b)
Ventilator weaning services performed in the pediatric subacute care unit shall
be covered separately for the purpose of decreasing or eliminating dependence
on mechanical ventilation, subject to the following criteria:
(1) The pediatric subacute care patient shall
be evaluated and deemed appropriate for a weaning trial by a physician with
knowledge of and experience in pediatric mechanical ventilation care and who
documents, at a minimum, the history of ventilator dependence, previous weaning
attempts, an a description of the weaning plan of treatment specifying
measurable functional goals within specified time frames and post-weaning
stabilization care intensity and duration.
(2) The appropriate health care professional,
as the result of a comprehensive patient assessment, shall develop a plan of
treatment which shall be integrated into an individualized comprehensive plan
of care consistent with an interdisciplinary team approach in meeting the
child's needs. A plan of treatment specifying measurable functional goals
within specified time frames shall include but not be limited to:
(A) A respiratory care practitioner's plan of
treatment that provides documentation of needed respiratory care practitioner
time greater than the three hours in a day, as required by Section
51215.8(t).
(B) A nursing plan of treatment that
documents the need for registered nurse assessments and subsequent skilled
nursing care interventions at specified intervals, but in any case, more than
three times in every 24 hours.
(c) Ventilator weaning services shall be
covered separately from the pediatric subacute care services authorized in
accordance with Section
51335.6(c).
(d) Ventilator weaning requests shall be
subject to the standards of medical necessity as set forth in Sections
51303(a) and
51340(e).
Authorization requests shall be initiated by the facility.
(1) For the initial request for ventilator
weaning, a treatment authorization request (TAR) shall be submitted within 10
working days of the development of the patient's plan of treatment accompanied
by the documentation in (b) of this section as appropriate.
(2) For reauthorization or requests for
continuation of ventilator weaning, a TAR shall be accompanied by a statement
describing the pediatric subacute care patient's progress and decreased
ventilator dependence achieved and the information required in (b)(1) of this
section updated to document continued medical necessity of these
services.
(3) Pediatric subacute
care patients for whom ventilator weaning is authorized shall remain eligible
for pediatric subacute care services authorized in accordance with Section
51335.6(c) for
the duration of authorization period for ventilator
weaning.
Notes
2. Certificate of Compliance as to 6-30-97 order transmitted to OAL 10-22-97 and filed 11-26-97 (Register 97, No. 48).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Section 14132.25, Welfare and Institutions Code.
2. Certificate of Compliance as to 6-30-97 order transmitted to OAL 10-22-97 and filed 11-26-97 (Register 97, No. 48).
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