1. The child is dependent on medical equipment on a daily basis; or
2. Skilled nursing care or comprehensive rehabilitative interventions are necessary, including:
Medications are necessary throughout the day
There is a high probability for complications or adverse reactions
Specialized professional training and monitoring are needed to assist parents
The child’s condition substantially interferes with the ability to engage in everyday activities and perform age appropriate activities of daily living at home and in the community
The daily routine is altered by the need to complete these specialized treatments or the need for assistance with self care activities.
3. The level of care indicated above shall meet all of the following criteria:
The child’s condition is expected to last at least one year
Hands on nursing or rehabilitative care must be provided daily
The child requires direct hands on assistance to perform treatments.
Hospital Level of Care Criteria:
1. The child has a severe, chronic health condition that is expected to last for at least one year.
2. The child requires a skilled nursing level of care daily including:
Hands on medical interventions
Rehabilitative care
Direct medical monitoring
Intense medical regimen
3. The child requires daily medical treatments including:
Substantial amount of time to complete
Training to perform treatment safely
The ability to recognize changes that require prompt interventions
The ability to modify treatment plans during the day.
Expedited Criteria:
Children needing an organ transplant
Children on a ventilator
Children in the hospital over 30 days and cannot discharge without services.