R432-104-7. Admission and Discharge Policy

  (1) An LTAC shall implement as an admission policy an average inpatient length of stay greater than 25 days and which complies with R432-104-7(2).

  (2) Patients who have one or more of the following conditions may be admitted to an LTAC:

  (a) the patient is medically unstable due to chronic or long-term illness and requires a weekly physician visit; or

  (b) the patient requires dangerous drug therapy, continuous use of a respirator or ventilator, or suctioning or nasopharyngeal aspiration at least once per nursing shift.

  (c) the patient requires skilled nursing services and care which requires a registered nurse present for care 24 hours per day for at least three of the following treatments at the specified frequency;

  (i) extensive dressings for deep decubiti, surgical wounds, or vascular ulcers daily;

  (ii) isolation for infectious disease 24 hours per day;

  (iii) suctioning three days per week;

  (iv) occupational therapy, physical therapy, or speech therapy five days a week;

  (v) respiratory therapy;

  (vi) special ostomy care daily;

  (vii) oxygen daily;

  (viii) traction; or

  (ix) catheter or wound irrigation daily.

  (3) Within 24 hours of admission the attending physician shall document:

  (i) The patient's current medical and respiratory status, including pertinent clinical parameters;

  (ii) Treatment plan and goals;

  (iii) Estimated length of stay; and

  (iv) Anticipated discharge plan.

  (4) The LTAC shall discharge the patient from the facility if:

  (a) the physician documents that the patient:

  (i) requires additional intense services in an acute hospital;

  (ii) exhibits no evidence of progress towards current, documented goals over an eight-week period and a medically appropriate alternative for discharge exists; or

  (iii) has met documented goals established at or modified following admission and medically appropriate alternatives for discharge exist; or

  (b) the patient or care giver exhibit ability to care for the patient's physical needs.