Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 60. Standards Established and Methods Used to Assure High Quality Care
7/13/2020

12VAC30-60-320. Adult Ventilation/Tracheostomy Specialized Care Criteria.

A. General description. The resident must have long-term health conditions requiring close medical supervision, 24 hour licensed nursing care, and specialized services or equipment.

B. The targeted adult population requiring specialized care includes individuals requiring mechanical ventilation and individuals with a complex tracheostomy who require comprehensive respiratory therapy services.

C. Criteria.

1. The individual must require at a minimum:

a. Physician visits at least once weekly. The initial physician visit must be made by the physician personally and subsequent required physician visits after the initial visit may alternate between personal visits by the physician and visits by a physician assistant or nurse practitioner.

b. Skilled nursing services 24 hours a day. A registered nurse must be on the nursing unit on which the resident resides, 24 hours a day, whose sole responsibility is the designated unit.

c. Respiratory services provided by a licensed board-certified respiratory therapist (these services must be available 24 hours a day).

d. Coordinated multidisciplinary team approach to meet needs.

2. In addition, the individual must meet one of the following two requirements:

a. Require a mechanical ventilator; or

b. Have a complex tracheostomy that meets all of the following criteria. The individual must:

(1) Have a tracheostomy, with the potential for weaning off of it, or documentation of attempts to wean, with subsequent inability to wean;

(2) Require nebulizer treatments followed by chest PT (physiotherapy) at least four times per day or nebulizer treatments at least four times a day, which must be provided by a licensed nurse or licensed respiratory therapist;

(3) Require pulse oximetery monitoring at least every shift due to demonstrated unstable oxygen saturation levels;

(4) Require respiratory assessment and documentation every shift by licensed respiratory therapist or trained nurse;

(5) Have a physician's order for oxygen therapy with documented usage;

(6) Require tracheostomy care at least daily;

(7) Have a physician's order for suctioning as needed; and

(8) Be deemed to be at risk of requiring subsequent mechanical ventilation.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia and Item 325 LLL of Chapter 1042 of the 2003 Acts of Assembly.

Historical Notes

Derived from VR460-03-3.1301 § 2, eff. June 29, 1994; amended, Volume 20, Issue 19, eff. July 1, 2004.

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