64C-4.002. Diagnostic and Treatment Facilities or Services - General

(1) Each chronic care hospital and skilled nursing care facility approved by the Department for the provision of health services to CMS participants must have or meet the following:

(a) An active, valid State of Florida license.

(b) Accreditation from the Joint Commission on Accreditation of Health Organizations (JCAHO).

(c) A physically definable hospital unit or ward to which only children are admitted. The entire pediatric unit or ward must maintain an annual average daily census of fifteen children or more, excluding normal newborns and those in neonatal intensive care units. In making the selection and designation of approved facilities, CMS will give priority to those facilities that demonstrate an emphasis on quality children’s medical services, including the presence of an adolescent unit or ward, a neonatal (level two or level three) intensive care unit, and a pediatric intensive care unit.

(d) Applicable national specialty standards, when available, commensurate with any specialty health care services provided by the facility that will be available to CMS participants.

(2) Each primary care hospital, approved by the CMS area office for the provision of health care to CMS participants, must have or meet the following:

(a) An active, valid State of Florida license;

(b) Accreditation from the Joint Commission on Accreditation of Health Organizations (JCAHO);

(c) A separate pediatric unit, which has at least five rooms available;

(d) A designated chief of pediatrics;

(e) Board certified pediatricians following the patients and available 24 hours a day;

(f) A qualified and experienced pediatric nursing staff with at least one RN on duty in the unit 24 hours a day;

(g) A pediatric code cart on the unit along with appropriate pediatric resuscitation equipment; and

(h) The capability for rapid transfer to pediatric intensive care units.

(3) When a hospital within a CMS Service area is the only facility available within that area to admit CMS participants, a provisional exception to the designation criteria shall be made by the Deputy Secretary for Children’s Medical Services, upon recommendation from the area CMS Medical Director, in order to provide participants access to health care not immediately available through CMS approved physician providers.

Specific Authority 391.026(18) FS. Law Implemented 391.026(10), 391.035 FS. History–New 1-1-77, Amended 2-11-85, Formerly 10J-5.08, Amended 3-28-96, Formerly 10J-5.008, Amended 2-2-03.