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.

  1. 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.
  2. A Respiratory Service Unit is a treatment or set of treatments up to 30 minutes in length.
  3. 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.
  4. 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.
  5. Radiology provided by the facility shall be those services obtainable by a portable x-ray service at the facility site.
  6. 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.
  7. Should the Payor elect not to provide the following services or products, charges from the facility shall apply:
  8. 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

  9. 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.
  10. 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 Excluded
    Not on Formulary-
    Easy Reference Exclusions
    Third-Generation Cephalosporins Rocephin (ceftriaxone)
    Fortaz (ceftazidime)
    Claforan (cefotaxime)
    Anti-Fungal Agents Diflucan
    Nizoral
    Amphotericin
    Flouroguinolones-antibiotics Ciprofloxacin
    Noroxin
    Levoguin
    All Antiviral Medications &
    Anti Retroviral
    Epivir
    Zovirax
    Viramune
    Zerit
    Cytovene
    Foscavir
    Biologicals Epogen Nevpocen
    Aminoglycoside Antibiotics Amikacin  
    Miscellaneous Antibiotics Flagyl Zithromax (azithromycin)
    Biaxin
    Pulmonary Medications Continuous Albuterol
    (over 24 hours)
    Helium
    Tilade
    Parenteral Analgesics for Pain Methadone  
    Management (continuous infusion) Morphine
    Dilaudid
     
    Volume Expanders/ Blood Products Albumin
    PRBC's
    Plasminogen
    Dialsate Solutions    
    Other Pentamidine Synagis