Common use of Long Term Acute Care Hospital Clause in Contracts

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 disorders • Patient continues to meet the criteria above and does not meet the criteria to be transitioned to alternate level of care. Benefits for eligible service expenses incurred for medically necessary treatment of an Acquired Brain Injury will be determined on the same basis as treatment for any other physical condition. Cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation; neurobehavioral, neuropsychological, neurophysiological and psychophysiological testing and treatment; neurofeedback therapy, remediation required for and related to treatment of an Acquired Brain Injury, post-acute transition services and community reintegration services, including outpatient day treatment services, or any other post-acute treatment services are covered, if such services are necessary as a result of and related to an Acquired Brain Injury. Treatment for an Acquired Brain Injury may be provided at a hospital, an acute or post-acute rehabilitation hospital, an assisted living facility or any other facility at which appropriate services or therapies may be provided. Service means the work of testing, treatment, and providing therapies to an individual with an Acquired Brain Injury. Therapy means the scheduled remedial treatment provided through direct interaction with the individual to improve a pathological condition resulting from an Acquired Brain Injury. To ensure that appropriate post-acute care treatment is provided, this plan includes coverage for reasonable expenses related to periodic reevaluation of the care of an individual covered who:

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 disorders • Patient continues to meet the criteria above and does not meet the criteria to be transitioned to alternate level of care. Benefits for eligible service expenses incurred for medically necessary treatment of an Acquired Brain Injury will be determined on the same basis as treatment for any other physical condition. Cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation; neurobehavioral, neuropsychological, neurophysiological and psychophysiological testing and treatment; neurofeedback therapy, remediation required for and related to treatment of an Acquired Brain Injury, post-acute transition services and community reintegration services, including outpatient day treatment services, or any other post-acute treatment services are covered, if such services are necessary as a result of and related to an Acquired Brain Injury. Treatment for an Acquired Brain Injury may be provided at a hospital, an acute or post-acute rehabilitation hospital, an assisted living a skilled nursing facility or any other facility at which appropriate services or therapies may be provided. Service means the work of testing, treatment, and providing therapies to an individual with an Acquired Brain Injury. Therapy means the scheduled remedial treatment provided through direct interaction with the individual to improve a pathological condition resulting from an Acquired Brain Injury. To ensure that appropriate post-acute care treatment is provided, this plan includes coverage for reasonable expenses related to periodic reevaluation of the care of an individual covered who: