Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 10 - SUBACUTE CARE › Section 17-1737-120 - Subacute patient care characteristics

Current through June, 2024
(a) To qualify for
				  subacute level of care under group I, patients, age twenty-one years and older,
				  must be medically stable and require continuous mechanical ventilation for at
				  least fifty per cent of each day.
(b) To qualify for subacute level of care
				  under group II, non-ventilator patients, age twenty-one years and older, who
				  require a higher level of service than SNF, but who do not require acute
				  hospital care, must be medically stable and require the following services:
(1) Tracheostomy care with suctioning
				  required at least once an hour;
(2)
				  Any combination of mechanical ventilation, tracheostomy care with suctioning
				  and inhalation treatment with or without oxygen at least once a
				  shift;
(3) Total parenteral
				  nutrition;
(4) Continuous
				  intravenous therapy for the administration of therapeutic agents or hydration,
				  or intermittent IV therapy for the administration of therapeutic drugs at least
				  once a shift through a peripheral or central line or both. Therapeutic agents
				  are to include antibiotics, non-vescicant oncology chemotherapy, and
				  analgesics;
(5) Stable newborns or
				  premature infants under age one, who have been inpatients in the acute hospital
				  for at least a week and cannot be discharged because they require any of the
				  following services:
(A) Monitoring episodes
				  of bradycardia and apnea which are resolved by manual stimulation in infants
				  for whom discharge from a facility is medically inappropriate; or
(B) Nasogastric tube or gastrostomy
				  feedings;
(6) Stable
				  patients admitted to the acute care hospital for infections, who are afebrile
				  for twenty-four hours on intravenous or parenteral antibiotics and undergoing
				  twenty-four to forty-eight hour trials of oral antibiotics or being trained to
				  infuse parenteral antibiotics in the home in preparation for discharge to the
				  home;
(7) Two or more of the
				  following services:
(A) Tracheostomy care
				  with suctioning required at least once a shift;
(B) Traction and pin care for fractures
				  (Bucks Traction is not included);
(C) Medically necessary isolation precautions
				  as recommended by the Centers for Disease Control. (Infection control measures
				  for the care of decubitus ulcers do not apply in this category);
(D) Debridement, packing, and medicated
				  irrigation with or without whirlpool treatment, aseptic dressing changes,
				  management of extensive (stage III) decubitus ulcers or wound infection, and JP
				  drains;
(E) Skilled nursing
				  services including but not limited to the monitoring, observation, and care of
				  patients with HIV infection/AIDS, patients who have terminal diseases, patients
				  who require chronic dialysis treatment, patients receiving radiation therapy,
				  patients receiving treatment for dehydration or monitoring of hydration, or
				  patients receiving treatment for pain control who have or are at high risk for
				  significant medical complications;
(F) Skilled nursing care including
				  observation, monitoring for the side effects of treatment for patients
				  receiving radiation therapy, or the monitoring of hydration and pain control
				  who have or are at high risk for significant medical complications;
(G) At least daily ventilation or inhalation
				  therapy services or both with or without oxygen;
(H) Treatment of patients with eating
				  disorders including bulimia and anorexia nervosa who require skilled
				  supervision and monitoring of food intake and psychiatric inpatient care and
				  are medically stable in the inpatient facility, but who are at high risk of
				  medical complications if discharged to outpatient care; or
(H) Treatment of psychiatric patients who are
				  not an immediate danger to themselves or others, but who require inpatient
				  monitoring, supervision, and psychiatric care because of high risk for
				  life-threatening complications to themselves or others if discharged to
				  outpatient care; or