Example (Skilled Care):

10-year-old with severe cardiac compromise requiring surgical intervention

Skilled Needs

• Assessment:
• • Trained and knowledgeable regarding changes in clinical condition and necessary intervention
• Interventions:
• • Parents monitor cardiovascular system changes
  • Oxygen therapy
  • Medication management requiring clinic judgment
  • Parents perform home exercise program (HEP) 3x/week
  • Requires assistance with most activities of daily living (ADLs)

Nursing Facility – Intermediate Care

• Patient is more stable and the focus is on maintenance therapy
• • Periods of instability
  • Maintenance medication management
  • Therapy services to prevent progressive disabilities

Example (Intermediate Care):

One year later - 10-year-old with severe cardiac compromise surgical intervention completed

• Intermediate Care Needs
• • Maintenance/preventative therapy services
  • • Off oxygen but limited respiratory capacity
    • Remains on potent cardiovascular medications
    • Physical therapy/occupational therapy 2x/week
  • Child learning self-care
  • Clinical status stabilized due to knowledge increase of parents

Inpatient Psychiatric Hospital (IPH)

Meeting the Criteria

• Criteria 1 (must include documentation)
• • Mental illness/severe emotional disturbance diagnosed by
    psychiatrist/mental health clinician
  • Has persisted 6 months
  • Expected to persist for 12 months or longer
• Criteria 2 (must include documentation)
• • Must have at least one of following mental health symptoms
  • • Psychotic symptoms
    • Suicidal behavior within 90 days prior to date of application
    • Significant suicidal thoughts within 30 days prior to date of application
    • Violent behavior within 30 days prior to date of application
• Other criteria (3 – 6) should be addressed in the supporting documentation

Example:

• 12-year-old female with schizophrenia for 2 years; under the care of psychiatrist
• Documented regular patterns of violent behavior requiring police intervention
• Functional impairments in all areas
• Interventions:
• • Safety needs
  • Mental health wrap around services 5x/week
  • Medication management
  • IEP to address school/behavioral needs