(a) Subject to the specifications, conditions, limitations,
and requirements established by the department or its designee, maternity
clinic services are those clinic services determined by a licensed physician
(MD or DO) to be reasonable and medically necessary for the care of a pregnant
female (patient) during the patient's prenatal period and subsequent 60-day
postpartum period. The physician prescribing the services must be employed
by or have a contractual agreement/formal arrangement with the clinic to assume
professional responsibility for the services provided to the clinic's patients.
(b) The physician must see each patient and prescribe or approve
each patient's plan of care. The physician must base the plan of care on a
risk assessment completed by the physician or by licensed, professional clinic
staff. The assessment must be based on findings obtained through a health
history, laboratory/screening services, and a physical examination. The department
or its designee establishes the criteria for assessing the patient's risk.
The level of services provided to the patient must be commensurate with the
risk assessment. Services must be provided on site or through referral or
other formal arrangement to patients experiencing a normal pregnancy and to
patients whose pregnancy places them at risk.
(c) Covered services must be furnished on an outpatient basis
by the physician or by licensed, professional clinic staff under the direction
of the physician. The physician and professional clinic staff must be licensed
by the state in which the services are rendered. Services provided by the
professional clinic staff must be within staff's scope of practice or licensure
as defined by state law.
(d) Covered clinic services include, but are not necessarily
limited to, risk assessment, medical services, laboratory/screening services,
case coordination/outreach, nutritional counseling, psychosocial counseling,
family planning counseling, and patient education regarding maternal and child
health.
(e) Although the physician does not necessarily have to be
present at the clinic when covered services are provided, the physician must
assume professional responsibility for the services provided at the clinic
and must ensure through approval of the plan of care that the services are
medically appropriate. The physician must spend as much time in the clinic
as is necessary to ensure that patients are receiving services in a safe and
efficient manner in accordance with accepted standards of medical practice.
(f) Clinics must have arrangements for referral of non-stress
test (NST), sonography, and amniocentesis for high-risk patients.
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Source Note: The provisions of this §354.1271 adopted to be effective October 17, 1988, 13 TexReg 4783; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561 |