OHCA Policies and Rules
317:30-5-133.3. Nursing home ventilator-dependent and tracheostomy care services
[Revised 10-25-24]
(a) Admission is limited to ventilator-dependent and/or high-acuity tracheostomy residents.
(b) The ventilator-dependent resident and/or high-acuity tracheostomy resident must meet the current nursing facility level of care criteria. (Refer to OAC 317:30-5-123.)
(c) All criteria must be present in order for a resident to be considered ventilator-dependent:
(1) The resident is not able to breathe without a volume with a backup.
(2) The resident must be medically dependent on a ventilator for life support six (6) hours per day, seven (7) days per week.
(3) The resident has a tracheostomy.
(4) The resident requires daily respiratory therapy intervention (i.e., oxygen therapy, tracheostomy care, physiotherapy or deep suctioning). These services must be available twenty four (24) hours a day.
(5) The resident must be medically stable and not require acute care services. A Registered Nurse or Licensed Practical Nurse must be readily available and have primary responsibility of the unit at all times.
(d) The resident will also be considered ventilator-dependent if all of the above requirements were met at admission but the resident is in the process of being weaned from the ventilator. This excludes residents who are on C-PAP or Bi-PAP devices only.
(e) All criteria must be present in order for a resident to be considered a high-acuity tracheostomy care resident:
(1) The resident is not able to breathe without the use of a tracheostomy.
(2) The resident requires daily respiratory therapy intervention (i.e., oxygen therapy, tracheostomy care, chest physiotherapy, or deep suctioning). These services must be available twenty four (24) hours a day.
(3) A Registered Nurse or Licensed Practical Nurse must be readily available and have primary responsibility of the unit.
(f) In addition to the requirements in paragraph (e), high-acuity tracheostomy residents will need to meet at least one (1) of the listed criteria below:
(1) The resident has a Brief Interview for Mental Status (BIMS) Interview score between zero and twelve (0-12) (moderately to severely impaired).
(2) The resident sees a pulmonologist monthly and a respiratory therapist at least once every other week, with a respiratory therapist available on call twenty four (24) hours a day.
(3) The resident is nonverbal, comatose, or in a vegetative state.
(4) The resident has a contractures diagnosis that results in limited mobility.
(5) The resident requires total dependency from staff with all aspects of daily care.
(6) The resident is unable to suction themselves.
(7) The resident requires tracheostomy deep suctioning at an increased frequency of at least ten (10) times daily due to thick, copious amounts of secretions.
(8) The resident is unable to clear their own secretions and protect their airway.
(9) The resident has been diagnosed with a progressive neurological disorder that results in muscle weakness; this includes, but is not limited to, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), Alzheimer’s, head injuries, or Cerebrovascular Accident (CVA).
(10) The resident requires five (5) L/min of oxygen or greater than 40% Fraction of Inspired Oxygen (FIO2).
(11) The resident requires breathing treatments that are at an increased frequency of three (3) or more times daily.
(12) The resident has an artificial opening in the neck for the tracheostomy, and an artificial opening in the abdomen for a gastrostomy tube.
(13) The resident has multiple co-morbidities, resulting in demonstrative complications.
(g) Not withstanding the foregoing, a ventilator-dependent or high-acuity tracheostomy resident who is in the process of being weaned from ventilator dependence or requiring qualified tracheostomy treatment shall continue to be considered a qualified resident until the weaning process is completed.
Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.
