California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 3 - Standards for Participation › Section 51215.6 - Participation Requirements for the Adult Subacute Program and Pediatric Subacute Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Adult subacute services and pediatric subacute services shall be provided by a
					 licensed general acute care hospital with distinct-part skilled nursing beds or
					 a freestanding certified nursing facility that enters into a contract with the
					 Department.
(b) Each applicant for
					 an initial contract, contract amendment, or contract renewal to provide adult
					 subacute services or pediatric subacute services, shall submit a completed
					 application, or written request in the case of contract amendment, to the
					 Department containing, but not limited to, evidence of the following:
(1) Licensure as a general acute care
					 hospital with or without distinct-part skilled nursing beds, a skilled nursing
					 facility or a Congregate Living Health Facility;
(2) Certification as a Medicare and Medi-Cal
					 provider;
(3) History as a licensed
					 health care facility for a period of 12 months prior to and during the initial
					 application process, contract amendment, or contract renewal as follows:
(A) Maintenance of an uninterrupted Medi-Cal
					 provider agreement; and
(B) As
					 applicable to the type of facility, all deficiencies in patient care, or
					 deficiencies of a severity which would impose immediate jeopardy or actual harm
					 to a resident's/patient's health or safety during a facility certification
					 survey, complaint survey or special incident investigation. The Department may
					 terminate a contract, impose contract penalties, or deny the award of a
					 contract, a contract amendment, or contract renewal in other instances of
					 deficiencies found during a facility certification survey, complaint survey or
					 special incident investigation that would not impose immediate jeopardy or
					 actual harm to a resident's/patient's health or safety, but are determined to
					 be widespread. These deficiencies are determined by the Department or the
					 Center for Medicare and Medicaid Services, and
(C) As applicable to the type of facility,
					 all citations as defined by Health and Safety Code Sections
					 1424(c), (d) and
					 (e) that pertain to patient care. The
					 presence of a citation or citations shall not, in itself, constitute the basis
					 for denial of the contract application, amendment or renewal. A citation or
					 citations shall be evaluated for impact on such areas as patient care, patient
					 safety, fraud and for indications of a pattern of
					 noncompliance.
(4) As
					 applicable to the type of facility, documentation that the applicant can comply
					 with one or more of the following:
(A) With
					 Section 51215.5 for adult subacute
					 services;
(B) With Section
					 51215.8 for pediatric subacute
					 services.
(5) An
					 applicant for an adult subacute or pediatric subacute contract shall, in
					 addition to the requirements of (b) of this section, provide evidence that the
					 location of the proposed subacute unit has a subacute population and a need for
					 subacute services. This evidence shall include a list of potential patients,
					 with each patient's Medi-Cal identification number, current level of care, and
					 the address of each patient's current location. The requirements of this
					 subsection shall also apply to adult subacute and pediatric subacute contract
					 amendments and renewals.
(6) An
					 applicant for an adult subacute or pediatric subacute contract that is a
					 general acute care hospital with distinct-part skilled nursing beds shall, in
					 addition to the requirements of (b)(3) of this section, have a history of
					 maintaining the appropriate accreditation for participation in the Medicare and
					 Medi-Cal programs, and maintaining supplemental authorization by Licensing and
					 Certification for a distinct-part which functions as a skilled nursing facility
					 service. The requirements of this subsection shall also apply to adult subacute
					 and pediatric subacute contract amendments and renewals.
(7) Nothing in this section shall preclude a
					 new licensee without a history of providing care in a licensed health care
					 facility from being eligible to enter into a contract with the Department to
					 provide subacute care services to adult or pediatric patients if all other
					 applicable requirements of the subacute care program are
					 met.