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CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES
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CALIFORNIA Cf1 LDREN S SERVICES MANUAL OF PROCEDURES. B QQ D J unitv NICU General ReQuirements and Procedure for CCS Program. 1 A hospital with an rIJICUwishing to participate in the CCS program as a Community. NICU for the purpose of providing care for sick infants shall be licensed by the. Department of Health Services DHS Licensing and Certification Division under. California Code of Regulations CCR Title 22 Division 5 Chapter 1 as an. a acute general hospital Article 1 Sections 70003 70005 and. b Intensive Care Newborn Nursery ICNN Article 6 Sections 70483 through. 2 A Community NICU, a shall be loc ted in a hospital approved by CCS as a Pediatric Community. Hospital as per Chapter 3 3 2 CCS Standards for Pediatric Community Hospitals. b shall be located in a hospital approved by CCS as a General Community Hospital. with licensed perinatal beds as per Chapter 3 3 3 CCS Standards for General. Community Hospitals or, c shall be locc3tedin a hospital approved by CCS as a Special Hospital which has. licensed perinatal beds as per Chapter 3 3 4 CCS Standards for Special. 3 Common surgical procedures may be performed on stable neonates in a Community. NICU that does not have CCS approval for Neonatal Surgery as per Chapter 3 34 CCS. Standards for Neonlatal Surgery, 4 A Community NICU shall only perform neonatal surgery 1including the performance of. patent ductus arteriosus PDA ligation if approved by CCS for Neonatal Surgery as per. Chapter 3 34 CCS Standards for Neonatal Surgery, 5 A Community NICU shall only perform PDA ligations in premature infants if approved by. CCS for PDA Ligation for Premature Infants as per C apter 3 34 5 CCS Standards for. PDA Ligation for Premature Infants, 6 A Community NICU shall have a Regional Cooperation Agreement as specified below.
a A Community NICU shall enter into written agreements approved by the CCS. program with an affiliated CCS approved Regional NICU s and may additionally. enter into wi itten agreements approved by the CCS program with affiliated. IntermediatE NICUs All Regional Cooperation Agreements shall specify mutual. responsibility for at least the following, 1 joint education and training of perinatal health professionals and. Issued 111 99 Chapter, CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES. CHAPTER 3 PROVIDER STANDARDS Community NICU, 2 joint development of guidelines for consultation by perinatal neonatal and. other specialty disciplines as necessary and, 3 joint development of guidelines for maternal and neonatal patient referral. and transport to and from each facility NICU and, 4 joint identification development and review of protocols policies and.
procedures related to the care of the high risk obstetric and neonatal. patiE nt at least every two years and, 5 joint review of outcome data according to CCS requirements at least. b The Regional Cooperation Agreement shall be developed negotiated signed and. dated prior 10 CCS approval by at least the following persons from hospital. 1 Hospital Administrator and,2 Medical Director of the NICU and. 3 Medical Director Maternal Fetal Medicine hospitals without licensed. perirlatal beds are exempt from this requirement and. 4 Nurse Administrator, c It shall be thle mutual responsibility of the Regional Community and Intermediate. NICUs to re iew annually and recommend any modifications of said agreement to. reflect the evaluation of outcome, 7 An NICU shall meet and maintain CCS Standards far Community NICUs as contained. within this Chapter All NICUs shall conform to the most current edition of the American. Academy of Pediatrics and The American College of Obstetricians and Gynecologists. AAP ACOG Iines for Perinatal Care Where there is a conflict with specific. AAP ACOG recommendations and CCS Standards the CCS Standards for NICUs shall. 8 A hospital wishing to participate in the CCS program for the purpose of providing care to. sick infants which meets NICU requirements shall complete a CCS NICU application in. duRlicate and submit both copies to Department of Health Services Chief Children s. Medical Services Branch California Children s Services Program 714 P Street Room. 350 P O Box 942732 Sacramento CA 94234 7320 Questions concerning the. standards and the 81pplication process should be directed to the appropriate CMS. Regional Office,9 Review Process,Issued 111 99 Chapter.
CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES. CHAPTER 3 PROVIDER STANDARD Community NICU, a Upon receipt the NICU application will be reviewed by the appropriate CMS. Regional Office A site visit will be scheduled if the documentation submitted by. the hospital appears to meet the CCS Standards for Community NICUs. b The site review shall be conducted by a state CCS review team in accordance. with established CCS procedures for site visits The team shall consist of State. staff augmerlted by consultant experts in the fields of neonatology neonatal. critical care nursing and as indicated by other medical specialists. c Approval shall be based on compliance with CCS Standards for Community. NICUs and upon site review of NICU procedures services provided patient chart. review the demonstration of community need and NICU patient outcome data. d Approval may be withheld if there is not a community need based on geographic. considerations and a lack of sufficient caseload that is necessary to maintain. proficiency in the care of critically ill neonates The CCS program may consult. with other dh isions or branches within the DHS such as the Maternal and Child. Health Branc h and or Licensing and Certification Division and with other state and. federal agencies to determine community need, 10 After the site visit the following types of approval actions may be taken by the CCS. a Full aQQroval is granted when all CCS Standards for Community NICUs are met. b Provisional 81ggroval may be granted when all CCS Standards for Community. NICUs appear to be met however additional documentation is required by the. CCS prograrn This type of approval may not exceed one year. c Conditional ClRRroval for a period not to exceed six months may be granted when. there are readily remediable discrepancies with program standards The hospital. must present a written plan for achieving compliance with program standards and. the plan mus t be approved by the CCS program If the discrepancies are not. corrected within the time frame specified by the CCS program approval shall be. terminated, d Denial is bas ed upon failure of the hospital to meet CCS program standards. 11 A hospital shall be notified in writing of the decision regarding approval status within 90. days after the site visit A hospital whose application has been denied may appeal the. decision by submitting a letter in writing to the Chief Children s Medical Services Branch. within 30 days of re eipt of the notification of denial. 12 Annually as determined by CMS the hospital shall submit a list of staff who meet the. qualifications as specified in the CCS Standards for Community NICUs to Department of. Health Services Children s Medical Services Branch Attention Center Desk 714 p. Street Room 398 p 0 Box 942732 Sacramento CA 94234 7320 This list shall be. Issued 111 99 Chapter 3 25 2 4, CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES. CHAPTER 3 PROVIDER STANDARDS Community NICU, accompanied by a copy of the most current hospital license Any changes in the.
professional staff or facility requirements mandated by these standards shall be reported. to the State CMS Branch at the address in Section 3 25 2IB 8 above within 30 days of. occurrence, 13 Periodic reviews of CCS approved NICUs may be conducted on an annual basis or as. deemed necessary by the CCS program If an NICU does not meet CCS program. requirements the NICU may be subject to losing CCS approval. c QQm llunit NICU CCS F rogram ParticiRation Reguirements. Facilities providing services to CCS eligible clients shall agree to abide by the laws. regulations and policies of the CCS and Medi Cal programs Specifically facilities shall. a Refer all neonates infants with potentially eligible CCS conditions to the CCS. program for review of CCS program eligibility, b Assist families with the CCS referral and enrollment process by providing CCS. application forms phone numbers and office locations. c Request prior authorization from the CCS program as per Title 22 Section 42180. d Notify the local CCS program office in a timely manner of specialized neonatal. transport methods for potentially eligible neonates infants to and from the. facility NICU, e Accept referral of CCS eligible clients including Medi Cal patients whose services. are authorized by CCS, f Serve CCS eligible clients regardless of race color religion national origin or. g Bill client s private insurance Medi Cal or Medicare within six months of service in. accordance with Medi Cal and Medicare regulations regarding claims submission. time frames or within 12 months for private insurance prior to billing CCS. including Medi Cal or Medicare if the client is eligible for such coverage. h Bill CCS within, 1 six months from the date of service if the client does not have third party.
insurance coverage or, 2 six months from the date of receipt of insurance paymentldenial including. an explanation of benefits from the insurance carrier or. 3 twelve months from the date of service if insurance carrier fails to respond. Issued 111 99 Chapter 3 25 2 5, CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES. CHAPTER 3 PROVIDER STANDARDS Community NICU, i Utilize electronic claims submission when available upon CCS request. j Accept ccs payment for authorized services in accordance with state regulations. as payment in full, k Provide copies of medical records discharge summaries and other information as. requested by the CCS program within ten working days of request. l Provide anrlual reports as requested by the CCS program. m Provide serlfjces in a manner that is family centered and culturally competent. including thl3 provision of translators and written materials. no Permit ccs staff to visit and monitor facilities to assure ongoing compliance with. CCS standards, 0 Assist and ooperate with CCS staff in the on site utilization review by CCS staff.
of services provided to CCS eligible clients, 2 Failure to abide by the regulations and procedures governing the CCS program may. result in removal of the hospital from the list of CCS approved facilities. D lunitv NICU Exclus Qn, 1 Hospitals that are formally and involuntarily excluded from participation in programs of. federal and state a Jencies shall automatically be excluded from participation in the CCS. 2 A hospital may also be excluded by the CCS program because of but not limited to the. a Failure to successfully complete the CCS approval process. b Inadequate and or untimely addressing of deficiencies identified during a CCS site. c Loss of Joint Commission on Accreditation of Healthcare Organizations. accreditation or, d Failure to abide by the laws regulations standards and procedures governing the. CCS program,E QQ n lunitv NICU Organim QQ, 1 There shall be a separate and identifiable administrative unit for the NICU. Issued 111 99 Chapter 3 25 2 6, CALIFORNIA CHILDREN S SERVICES MANUAL OF PROCEDURES.
CHAPTER 3 PROVIDER STANDARDS Community NICU, 2 Medical care of the Community NICU shall be under the direction of a medical director. a Who shall meet the qualifications contained in Section 3 25 2 F. b Whose primary responsibility shall be the organization and supervision of the. Community NICU and, c Who shall not be the medical director of more than one NICU Regional. Community or Intermediate other than at the same contiguous medical building. 3 There shall be a Community NICU nurse manager, a Who shall have the responsibility on a 24 hour basis for the organization. management supervision and quality of nursing practice and nursing care in the. b Who shall not be a nurse manager of more than one NICU other than at the same. contiguous rnedical building complex and, c Who shall meet the requirements contained in Section 3 25 2 F. 4 The Community NICU medical director and the Community NICU nurse manager shall. have joint responsibility for the development and review of an ongoing quality. improvement program, 5 The Community NIC U medical director and the Community NICU nurse manager shall.
have joint responsibility for development and review of a Policies and Procedures Manual. for the NICU which addresses at a minimum patient admission patient care discharge. and transfer criteria, 6 There shall be an identified NICU multidisciplinary team. a Which shall have the responsibility for the coordination of all aspects of patient. b Which shall consist of at a minimum a CCS paneled neonatologist a clinical. nurse specialist a respiratory care practitioner and a CCS paneled medical social. worker with current experience and practice in neonatal care and whose. professional requirements are defined in Section 3 25 2 F Optional members of. the Community NICU multidisciplinary team may include but are not limited to the. following CCS paneled clinical registered dietitian CCS paneled occupational. therapist and CCS paneled physical therapist, F Community NICU Professional Resources and ReQuirements. c Continuing care is that care which is provided to neonates and infants who require 1 greater than or equal to six hours but less than eight hours of nursing care by a registered nurse per 24 hour period and 2 may have previously received intermediate or intensive care but who no longer require these levels of care

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