The purpose of this section is to guide the management and care of patients receiving hospital at home services as defined in RCW 70.41.550 (5)(a). Hospitals are not required to provide these services in order to be licensed. Hospitals must meet all inpatient service requirements in this chapter unless specified within this section. If providing hospital at home services, the hospital must:

(1) Provide or contract for the following services:

(a) Pharmacy;

(b) Infusion;

(c) Respiratory care including oxygen delivery;

(d) Diagnostics like laboratory and radiology services;

(e) Patient monitoring with at least two sets of patient vitals daily;

(f) Transportation;

(g) Food and dietician services including meal availability as needed by the patient;

(h) Durable medical equipment;

(i) Physical, occupational, and speech therapy;

(j) Social work and care coordination;

(2) Adopt and implement detailed policies and procedures for:

(a) Meeting the pharmaceutical needs of each patient;

(b) Performing IV push and IV piggyback infusions;

(c) Providing respiratory care to patients including response times, the availability of oxygen delivery and treatment, nebulizer treatment, and any other respiratory services;

(d) Providing diagnostic studies including which laboratory studies, radiology tests, or other diagnostics are available, the expected time between the order placement and results, which diagnostic studies are unavailable in home, and how the hospital will provide services;

(e) Obtaining and delivering at least two sets of patient vital signs daily to an individual credentialed by the department of health that is working within the scope of their license and is part of the hospital team. Vital signs must include, at a minimum, heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature;

(f) Transporting patients between the emergency department and their homes, and back to the hospital if needed. Policies and procedures must include whether transport is provided by ambulance, nonambulance medical transport, or other means as medically appropriate;

(g) Providing meal services to patients to ensure the availability of meals as needed by the patient;

(h) Delivering the range of durable medical equipment that may be required during an acute hospital care at home admission;

(i) Delivering physical, occupational, and speech therapists to the home, including the ability to provide these services on same-day basis and during the course of an acute hospital care at home admission;

(j) Social work and care coordination teams. Policies and procedures must describe how these services will interact with patients and the discharge process;

(k) Selecting patients for acute hospital care at home. The policy must explain:

(i) If a published selection criteria is used or has been adapted or if criteria has been developed by the hospital;

(ii) All inclusion and exclusion criteria; and

(iii) A description of how the hospital ensures that only patients requiring an acute level of care are treated in the program;

(l) Staffing models that explain how the minimum level of oversight and care described in subsection (3)(c) and (e) of this section will be met;

(m) Technology and device use, staffing, and any limitations based on time of day or weekend;

(n) Meeting a 30 minute in-person response time with appropriate emergency personnel. The policy must:

(i) Include the algorithm and timing of each step in the process, including how to identify and correct response times that have not been met;

(ii) Describe which personnel will travel to the home;

(iii) Describe any partnerships with local paramedic groups or other professionals who will improve this response time; and

(iv) Detail equipment that will travel with this team;

(3) Ensure that:

(a) Each patient is admitted to acute hospital care at home from an emergency room or inpatient hospital;

(b) A provider with admitting privileges performs a history and physical exam in-person on each patient prior to admitting to the acute hospital care at home program;

(c) A physician, physician assistant, or advanced practice registered nurse must examine, remotely or in-person, each patient at least daily;

(d) There are at least two in-person visits by clinicians each day for each patient;

(e) There must be at least one in-person or remote visit with a registered nurse who develops and documents an individualized nursing plan;

(f) Each patient must be able to remotely connect to a hospital team member at all times;

(g) The hospital must meet a 30 minute in-person response time with appropriate emergency personnel;

(h) A minimum emergency response time can be met for each patient by providing:

(i) Immediate, on-demand remote audio connection with an acute hospital care at home team member who can immediately connect a registered nurse, physician, physician assistant, or advanced practice registered nurse to the patient; and

(ii) In-home appropriate emergency personnel team that can arrive at the patient's home within 30 minutes. This can be provided by 911 or emergency paramedics;

(4) Track and report data. Hospitals must:

(a) Track all data metrics required by the Centers for Medicare and Medicaid Services for hospital at home programs and must track, at a minimum, the following:

(i) Unanticipated mortality during the acute episode of care;

(ii) Escalation rate which for the purpose of this section is considered the transfer back to the traditional hospital setting during the acute episode;

(iii) Volume of patients treated in this program;

(b) Submit to the department, on request, all required hospital at home data;

(c) Establish a hospital safety committee to review required hospital at home data metrics or incorporate the review of hospital at home data into an existing safety or quality committee;

(5) Inform the department that the hospital intends to provide acute care hospital at home services. Hospitals must complete and submit application forms provided by the department and the application fee listed in WAC 246-320-199.