Long Term Acute Care Hospital. Long-term acute care hospitals (LTACHs) furnish extended medical and rehabilitative care to individuals with clinically complex problems, such as multiple acute or chronic conditions, that need hospital-level care for relatively extended periods. Common conditions/services that may be considered medically necessary for LTACH level of care included, but not limited to: • Complex wound care: o Daily physician monitoring of wound o Wound requiring frequent complicated dressing changes, and possible repeated debridement of necrotic tissue o Large wound with possible delayed closure, draining, and/or tunneling or high output fistulas o Lower extremity wound with severe ischemia o Skin flaps and grafts requiring frequent monitoring • Infectious disease: o Parenteral anti-infective agent(s) with adjustments in dose o Intensive sepsis management o Common conditions include osteomyelitis, cellulitis, bacteremia, endocarditis, peritonitis, meningitis/encephalitis, abscess and wound infections • Medical complexity: o Primary condition and at least two other actively treated co-morbid conditions that require monitoring and treatment o Common conditions include metabolic disorders, stroke, heart failure, renal insufficiency, necrotizing pancreatitis, emphysema (COPD), peripheral vascular disease, and malignant/end- stage disease • Rehabilitation: o Care needs cannot be met in a rehabilitation or skilled nursing facility o Patient has a comorbidity requiring acute care o Patient is able to participate in a goal-oriented rehabilitation plan of care o Common conditions include CNS conditions with functional limitations, debilitation, amputation, cardiac disease, orthopedic surgery • Mechanical ventilator support: o Failed weaning attempts at an acute care facility o Patient has received mechanical ventilation for 21 consecutive days for 6 hours or o more/day o Ventilator management required at least every 4 hours as well as appropriate diagnostic services and assessments o Patient exhibits weaning potential, without untreatable and/or progressive lung and/or neurological conditions o Patient is hemodynamically stable and not dependent on vasopressors o Respiratory status is stable with maximum PEEP requirement 10 cm H2O, and FiO2 60 percent or less with O2 saturation at least 90 percent o Common conditions include complications of acute lung injury, disorders of the central nervous and neuromuscular systems, and cardiovascular, respiratory, and pleural/chest wall disorder...
