The nursing facility must meet the following quality standards established by the Alabama Medicaid Agency:

1. (1) Staffing levels that correlate with the number of ventilator-dependent residents.
2. (2) Respiratory therapy staff available in-house 24 hours a day—employee or contractual.
3. (3) Staff knowledge: At least one full-time professional staff member who has completed a course in the care of ventilator-dependent and tracheostomy individuals.

4. (4) Ongoing training

   1. (a) All staff providing care to ventilator-dependent and tracheostomy residents must receive training in the provision of ventilator care and tracheostomy care by a licensed Respiratory Therapist or a physician who is a Board Certified Pulmonologist.
   2. (b) Annual in-service training is required and must be conducted by a Respiratory Therapist or a physician who is a Board Certified Pulmonologist.

5. (5) Documentation

   1. (a) Written admission and discharge criteria specifying the medical requirements the resident must meet.
   2. (b) A written weaning program.
   3. (c) Admission, transfers and discharge policies.
6. (6) Access to other services, including specialty and ancillary services.

7. (7) Physical plant requirements.

   1. (a) The presence of an alarm system.
   2. (b) Suitable power supply for ventilators including an alternate power source.

Author: Marilyn F. Chappelle, Director, Long Term Care Division

Statutory Authority: State Plan; Title XIX, Social Security Act; and 42 CFR Section 401, et seq., Section 483.75.

History: New Rule: Filed December 12, 2011; effective January 16, 2012.