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Discharge & Rehabilitation Guidelines


Blue Cross of Idaho and our care management team are dedicated to helping members receive the right care, at the right time, in the right place.  Towards that end, we’ve developed guidelines for providers to help ensure our members receive the most appropriate care under their coverage criteria.

Discharge Guidelines
Before discharge from the hospital:

  • Pain must be under control, with oral medication, for at least 24 hours
  • Breathing must be stable and any shortness of breath controlled. Blood oxygen levels should be normal or at 90% when active
  • Patient must be able to eat and drink without difficulty, or if  on alternate nutrition from feeding tubes, must demonstrate tolerance for at least 24 hours
  • Fractures must be stabilized
  • Patient must have had a bowel movement in the prior 48 hours
  • Patient must be able to urinate and have no signs or symptoms of infection
  • Patient should have no infections, or if signs and symptoms of an infection exists, a plan for treatment must be established

Sub-Acute Rehabilitation

Below are some of the requirements to be eligible for sub-acute rehabilitation.
Patient must:

  • Need the services of a team which can consist of physicians, therapists, nurses and Blue Cross of Idaho care management staff
  • Be able to sit up for 30 minutes
  • Need at least two of the following:  Physical therapy, occupational therapy or speech therapy
  • Be able to walk while complying with weight bearing restrictions as set forth by the doctor
  • Be able to actively participate in therapy for two hours a day, six days a week
  • Need  to see a physician or nurse practitioner a minimum of once a week
  • Be able to show continuous improvement in therapies
  • Be able to learn, follow directions and carry over from day to day
  • Want to participate in their therapy
  • Need rehabilitation services as an in-patient rather than as an out-patient or in the home

Acute Rehabilitation

Below are some of the requirements that must be met to be eligible for acute rehabilitation.

Patient must:

  • Need the services of a team which can consist of physicians, therapists, nurses and Blue Cross of Idaho care management  staff
  • Be able to sit up for one hour
  • Need physical therapy, occupational therapy and speech therapy
  • Need nursing care from a registered nurse with specialized rehabilitation training
  • Be able to actively participate in therapy for three hours a day, six days a week
  • Need the services of a physiatrist (rehabilitation physician) a minimum of five times per week
  • Be able to show continuous improvement in therapies
  • Be able to learn, follow directions and carry over from day to day
  • Want to participate in therapy
  • Need rehabilitation services at a hospital rather than in a skilled nursing facility

Some examples of when acute rehabilitation may be appropriate are; recovery from a severe stroke, brain injury or spinal cord injury.

Patient must meet specific guidelines for Blue Cross of Idaho to approve coverage or pay for rehabilitation services.