Cal. Code Regs. Tit. 22, § 51242.1 - EPSDT Supplemental Services Provider -Pediatric Day Health Care Facility
(a) A pediatric day health care facility, as
defined in Section
51184(k)(2),
seeking to provide pediatric day health care EPSDT services shall be considered
to be an EPSDT supplemental services provider and shall comply with the
provisions specified in this section and in Section
51242, except the provisions of
subsections (a), (c) and (e). In addition, the pediatric day health care
facility shall maintain documentation available for Department review
substantiating compliance with all of the provisions of this section.
(b) The pediatric day health care facility
shall provide the required EPSDT services specified in Section
1760.6
of the Health and Safety Code, with the exception of Section
1760.6(b)(5).
(c) The pediatric day
health care facility shall comply with the personnel requirements specified in
Section
1267.13
of the Health and Safety Code. Such personnel, as required to provide the
services pursuant to paragraph (b) of this section, shall be:
(1) Licensed, certified or credentialed
health professionals acting within their scope of practice who meet the
experience requirements specified in this section; and
(2) Present in the facility in sufficient
numbers, as determined under the patient classification system defined in Title
22, California Code of Regulations, Section
70053.2, during all hours of
facility operation to provide services as prescribed by the attending physician
and documented in the individual plan of treatment and to address projected
admissions, terminations and emergencies.
(d) In complying with the provisions of
paragraph (c) of this section, the following requirements shall apply:
(1) Registered nurse personnel shall upon
hire provide to the employer evidence of all of the following:
(A) Current California licensure as a
registered nurse, and a minimum of two years of experience within the last five
years which includes the provision of nursing services to children with the
types of medical conditions for which the facility provides care. For those
registered nurses serving in a supervisory capacity, such experience shall
include nursing supervision; and
(B) Within one year of his or her date of
hire, proof of completion of at least thirty (30) continuing education units
specific to the physical and psychosocial assessment of, and provision of
nursing services to, children with the types of medical conditions for which
the facility provides care.
(2) Licensed nurse personnel, other than
registered nurses, shall provide to the employer evidence, upon hire, of a
minimum of six months' experience within the past two years providing care to
children with the types of medical conditions for which the facility provides
care; or an acquired competency, to be documented in the licensed nurse's
personnel records, including:
(A) Proof of
completion, within one year of his/her date of hire, of at least 15 continuing
education units specific to the provision of care to children with the types of
medical conditions for which the facility provides care, and
(B) Proof of completion, within two months of
employment, of at least 40 hours of direct employee specific preceptorship,
provided by a registered nurse meeting the qualifications specified in
subsection (1). For purposes of this section "preceptorship" means the pairing
of the newly hired nurse with a registered nurse who has met the experience and
education qualifications specified in subsection (1), for the purpose of
promoting the clinical competency of the newly hired nurse in providing nursing
services to the types of patients for whom the facility provides care. Such a
preceptorship may be provided during the licensed nurses' normal working tour
of duty.
(3) If the
facility provides care to a child who is dependent on mechanical ventilation,
the facility shall employ a licensed respiratory care practitioner, or a
licensed nurse with documented education, preparation and expertise specific to
the assessment and treatment of the ventilator dependent child. Such personnel
shall be present in the facility during all hours in which the ventilator
dependent child is present in the facility.
(4) If the facility utilizes nonlicensed
nursing personnel pursuant to Section
1337
of the Health and Safety Code, such personnel shall, upon hire, provide
evidence of a minimum of six months' experience within the past year providing
care to children with the types of medical conditions for which the facility
provides care.
(5) All medical
personnel shall:
(A) Have upon hire, and
subsequently maintain, pediatric cardiopulmonary resuscitation certification,
or
(B) Prior to the completion of
the orientation period described in Title 22, California Code of Regulations,
Section 72517(d), obtain,
and subsequently maintain, pediatric cardiopulmonary resuscitation
certification.
(e) The facility shall collaborate with and
involve the child's parent, foster parent or legal guardian in the decision
making process for all care planning and provision of interventions and
treatment at the facility and in the child's home. Such collaboration shall be
provided by the director or personnel delegated by the director, and shall
involve, at a minimum:
(1) A conference with
the child's parent, foster parent or legal guardian to be held quarterly, or
more frequently as indicated by the needs of the child or parent, foster parent
or legal guardian, to provide, at a minimum:
(A) A written status report on the plan of
treatment of the child at the facility.
(B) Information on the interventions and
treatments specified in the child's plan of treatment.
(2) A written report of the day's events
provided to the parent, foster parent or legal guardian at the conclusion of
each day of attendance specifying information including but not limited to:
(A) Treatments provided and when they were
provided.
(B) Medications
administered, including amount, time and route of dosage.
(C) Nutritional intake, including amount,
time and route of intake.
(D)
Developmental activities.
(E)
Contact with the attending physician.
(f) The facility shall work in conjunction
with the Regional Center, as defined in Title 17, Section 54302(a)(49), or the
Local Education Agency Provider, as defined in Title 22, Section
51190.2, in the development and
implementation of an age appropriate Individualized Family Service Plan (IFSP),
Individualized Education Plan (IEP) and/or Individualized Health and Support
Plan (IHSP) as specified in Government Code Section
95020, for
each child. The facility shall incorporate those identified activities in the
IFSP, IEP, and/or IHSP as appropriate, into the individual plan of treatment.
To facilitate continuity of services, the facility shall obtain instruction for
its personnel from the Regional Center or Local Education Agency Provider in
performing activities identified in the IFSP, IEP, and/or IHSP.
(g) During any work shift, personnel employed
by the facility shall not be simultaneously assigned duties at a licensed
health care facility, including but not limited to, a skilled nursing facility
or a congregate living health facility as defined in Division 2, Chapter 2,
commencing with Section
1250
of the Health and Safety Code.
(h)
The facility shall accept and retain only those beneficiaries for whom it can
provide adequate, safe, therapeutic and effective care as determined by the
attending physician and documented in the child's individualized plan of
treatment.
(i) Pharmaceutical
services, as required by paragraph (b) of this section, shall be:
(1) Supplied to the licensed nursing
personnel of the facility by the child's parent, foster parent or legal
guardian in the original dispensing container which specifies administration
instructions, except when a verbal order is obtained from the attending
physician and the medication is delivered to the facility by a pharmacy. In
such a case, the facility shall provide the container with the new medication
to the child's parent, foster parent or legal guardian the same day the
medication was delivered to the facility. Administered only upon written and
signed orders of the child's attending physician.
(2) All physician orders shall be current and
maintained in the child's medical record at the facility. Verbal orders from
the attending physician for services to be rendered at the facility may be
received and recorded by licensed nursing personnel in the child's medical
record at the facility and shall be signed by the attending physician within
thirty (30) working days.
(3)
Administered by facility personnel acting within the scope of their
practice.
(j) Nutrition
services, as required by paragraph (b) of this section, shall include a minimum
of one meal per day, between meal nourishment, and consultation services by the
facility's dietitian. Therapeutic diets, as defined in Title 22, Section
72115, and between meal
nourishment shall be provided and served as prescribed by the attending
physician. The child's parent, foster parent or legal guardian shall supply the
facility with baby food, baby formula, enteral formula, and any other food or
snack items not included in the facility's fixed meal menu. The administration
of all food shall be supervised by licensed or certified personnel functioning
within their scope of practice and documented in the plan of
treatment.
(k) Each pediatric day
health care facility shall provide readily available emergency health services
as follows:
(1) The facility shall obtain a
written agreement from the child's parent, foster parent or legal guardian
granting the facility permission to transfer the child to a hospital or other
health facility in case of an emergency.
(2) The facility shall maintain written
agreements for the provision of emergency medical care which shall include:
(A) An on-call physician.
(B) Hospital or emergency room
care.
(C) Medical
transportation.
(3) First
aid services shall be available at the facility. All personnel shall receive
in-service training in first aid. Training in cardiopulmonary resuscitation
shall be in accordance with Sections
51242.1(d)(5)(A) and
(B).
Notes
2. Certificate of Compliance as to 11-10-99 order, including amendment of subsections (d)(1)(A) and (d)(2), new subsections (d)(2)(A)-(B) and amendment of subsections (i)(2) and (j), transmitted to OAL 3-8-2000 and filed 4-19-2000 (Register 2000, No. 16).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Section 14132.10, Welfare and Institutions Code.
2. Certificate of Compliance as to 11-10-99 order, including amendment of subsections (d)(1)(A) and (d)(2), new subsections (d)(2)(A)-(B) and amendment of subsections (i)(2) and (j), transmitted to OAL 3-8-2000 and filed 4-19-2000 (Register 2000, No. 16).
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