Totally Kids® Specialty Healthcare
Pediatric Sub Acute Care for Children
who are Medically Fragile and/or Dependent on Technology
Levels of Care
Totally Kids® Specialty Healthcare is licensed by the State of California as a Skilled Nursing Facility and provides pediatric subacute nursing services under the general oversight of a physician Medical Director.
PER DIEM RATE
$ __________
LEVEL II PEDIATRIC SKILLED NURSING
Room (2, 3, or 4-beds per room)
24-hour skilled care from licensed personnel (LVN Primary) and
Certified Nursing Assistants.
Bowel & Bladder Management, Intermittent Catheterization
Basic Ostomy Care
Gastric, Nasogastric tube Management
Wound Care, Stage I-II
Diabetic Care
Apnea monitoring, as indicated
Intermittent Pulse Oximetry
Routine Oral or Injectable Medications with Administration
Per Facility Formulary and Basic non-legend meds
I.V. Therapy Maintenance for Hydration
Up to Two Respiratory Service Units Daily
General lab and portable radiology services
Standard dietary provisions
Under the oversight of a Registered Dietitian, including basic
enteral feeding formulas and supplies, if needed.
Individualized Developmental and Activities program
Under the oversight of a Child Life Specialist
Assessments for PT, OT, ST (Physiatrists' assessments to be billed separately)
$ __________
LEVEL III PEDIATRIC SUBACUTE (Includes LEVEL II)
Tracheostomy Care
Wound Care, Including Debridement and Packing
Up to Four Respiratory Service Units daily
I.V. Therapy with Single Drug Additive
$ __________
LEVEL IV PEDIATRIC SUBACUTE (Includes LEVEL III)
I.V. Therapy with Multiple Drug Additives
Pain Management (I.V., CADD Pump)
Continuous Pulse Oximetry
Intermittent Capnography
Up to eight Respiratory Service Units daily
Ventilator and Ventilator Services
$ __________
LEVEL V PEDIATRIC INTENSIVE SUBACUTE (Includes LEVEL IV)
Resident Requires One of the Following:
- Direct RN Management
- TPN/Lipid Administration
- Greater than eight Respiratory Service Units daily
- Isolation in excess of 7 days
REHABILITATION ADD-ON
Step A
$ ______per day
5-19 units weekly of Therapy (PT,OT and/or Speech)
Step B
$ ______per day
20-39 units weekly of Therapy (PT,OT and/or Speech)
Step C
$ ______per day
40-60 units weekly of Therapy (PT, OT and/or Speech)
1 unit of therapy equals 15 minutes.
DEFINITIONS AND MEMORANDA
Licensed Nursing Care is provided by RN's and LVN's who receive special training in pediatric nursing for the subacute resident.
Respiratory Therapy services are performed under the oversight of Licensed Respiratory Care Practitioners who are members of an in-house team.
Medical Case Management is provided by full-time Pediatric Nurse Practitioners who participate in the care planning for all residents.
- Recommendations for an increase in a CARE LEVEL shall be made within 24 hours (or first business day) of a change in condition which warrants a change in CARE LEVEL, and shall be authorized from the date of the change in condition. Residents shall remain at the authorized CARE LEVEL for not less than five days, unless discharged or authorized for a higher level.
- A Respiratory Service Unit is a treatment or set of treatments up to 30 minutes in length.
- A Therapy Unit (other than Respiratory therapy) is a treatment or partial treatment rendered by an allied health therapist up to fifteen minutes in length.
- Lab Services provided by the facility shall be those for which specimens and draws can be obtained at the facility and which are considered routine in a subacute setting. Not included are lab services for TPN and reference work.
- Radiology provided by the facility shall be those services obtainable by a portable x-ray service at the facility site.
- Ventilator rental rates are included in the rates for level IV and V provided ventilators are of a type in use at the facility. Examples of these ventilators are LP-10, Newport Wave and T-Bird.
- Should the Payor elect not to provide the following services or products, charges from the facility shall apply:
-
Cost plus 5%
1. T.P.N. medications and solutions
Cost plus 5%
2. Legend medications-client specific-not included on facility formulary
Cost plus 5%
3. Take-home and patient-specific DME, including wheelchairs.
Cost plus 5%
4. Special Enteral Feeding Formulas
(Billing information from facility shall include invoice or pre-determined price list.)
Pharmaceutical Coverage and Exclusions
- Excluded from the per diem rate of this agreement are all T.P.N. medications and solutions, and all brand name pharmaceuticals for which there exists a reasonably effective generic alternative.
- The facility-provided legend medications included in the per-diem rates shall
conform to the Medi-Cal formulary subject to the following exclusions:
On Medi-Cal Formulary
but now ExcludedNot on Formulary-
Easy Reference ExclusionsThird-Generation Cephalosporins Rocephin (ceftriaxone)
Fortaz (ceftazidime)Claforan (cefotaxime) Anti-Fungal Agents Diflucan
NizoralAmphotericin Flouroguinolones-antibiotics Ciprofloxacin
NoroxinLevoguin All Antiviral Medications &
Anti RetroviralEpivir
Zovirax
Viramune
ZeritCytovene
FoscavirBiologicals Epogen Nevpocen Aminoglycoside Antibiotics Amikacin Miscellaneous Antibiotics Flagyl Zithromax (azithromycin)
BiaxinPulmonary Medications Continuous Albuterol
(over 24 hours)Helium
TiladeParenteral Analgesics for Pain Methadone Management (continuous infusion) Morphine
DilaudidVolume Expanders/ Blood Products Albumin
PRBC'sPlasminogen Dialsate Solutions Other Pentamidine Synagis