(a) Subject to the specifications, conditions, limitations,
and requirements established by the Texas Health and Human Services
Commission (HHSC) 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 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. HHSC 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; amended to be effective June 2, 2024, 49 TexReg 3795 |