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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 133HOSPITAL LICENSING
SUBCHAPTER KHOSPITAL LEVEL OF CARE DESIGNATIONS FOR MATERNAL CARE
RULE §133.203General Requirements

(a) The Office of Emergency Medical Services (EMS)/Trauma Systems (office) shall recommend to the Executive Commissioner of the Health and Human Services Commission (executive commissioner) the designation of an applicant/healthcare facility as a maternal facility at the level for each location of a facility, which the office deems appropriate.

(b) A healthcare facility is defined under this subchapter as a single location where inpatients receive hospital services or each location if there are multiple buildings where inpatients receive hospital services and are covered under a single hospital license.

(c) Each location shall be considered separately for designation and the office will determine the designation level for that location, based on, but not limited to, the location's own resources and level of care capabilities; Perinatal Care Region (PCR) capabilities; and compliance with Chapter 133 of this title (relating to Hospital Licensing).

  (1) Level I (Basic Care). The Level I maternal designated facility will:

    (A) provide care for pregnant and postpartum patients who are generally healthy, and do not have medical, surgical, or obstetrical conditions that present a significant risk of maternal morbidity or mortality; and

    (B) have skilled personnel with documented training, competencies and annual continuing education specific for the patient population served.

  (2) Level II (Specialty Care). The Level II maternal designated facility will:

    (A) provide care for pregnant and postpartum patients with medical, surgical, and/or obstetrical conditions that present a low to moderate risk of maternal morbidity or mortality; and

    (B) have skilled personnel with documented training, competencies and annual continuing education specific for the patient population served.

  (3) Level III (Subspecialty Care). The Level III maternal designated facility will:

    (A) provide care for pregnant and postpartum patients with low risk conditions to significant complex medical, surgical and/or obstetrical conditions that present a high risk of maternal morbidity or mortality;

    (B) ensure access to consultation to a full range of medical and maternal subspecialists and surgical specialists, and behavioral health specialists;

    (C) ensure capability to perform major surgery on-site;

    (D) have physicians with critical care training available at all times to actively collaborate with Maternal Fetal Medicine physicians and/or Obstetrics and Gynecology physicians with obstetrics training and privileges in maternal care;

    (E) have skilled personnel with documented training, competencies and annual continuing education, specific for the population served;

    (F) facilitate transports; and

    (G) provide outreach education to lower level designated facilities, including the Quality Assessment and Performance Improvement (QAPI) process.

  (4) Level IV (Comprehensive Care). The Level IV maternal designated facility will:

    (A) provide comprehensive care for pregnant and postpartum patients with low risk conditions to the most complex medical, surgical and/or obstetrical conditions and their fetuses, that present a high risk of maternal morbidity or mortality;

    (B) ensure access to on-site consultation to a comprehensive range of medical and maternal subspecialists, surgical specialists and behavioral health specialists;

    (C) ensure capability to perform major surgery on-site;

    (D) have physicians with critical care training available at all times to actively collaborate with Maternal Fetal Medicine physicians and/or Obstetrics and Gynecology physicians with obstetrics training, experience and privileges in maternal care;

    (E) have a maternal fetal medicine critical care team with expertise and privileges to manage or co-manage highly complex, critically ill or unstable maternal patients;

    (F) have skilled personnel with documented training, competencies and annual continuing education, specific for the patient population served;

    (G) facilitate transports; and

    (H) provide outreach education to lower level designated facilities, including the QAPI process.

(d) Facilities seeking maternal facility designation shall be surveyed through an organization approved by the office to verify that the facility is meeting office-approved relevant maternal facility requirements. The facility shall bear the cost of the survey.

(e) PCRs.

  (1) The PCRs are established for descriptive and regional planning purposes and not for the purpose of restricting patient referral.

  (2) The PCRs will consider and facilitate transfer agreements through regional coordination.

  (3) A written plan identifies all resources available in the PCRs for perinatal care, including resources for emergency and disaster preparedness.

  (4) The PCRs are geographically divided by counties and are integrated into the existing 22 TSAs and the applicable Regional Advisory Council (RAC) of the TSA provided in §157.122 of this title (relating to Trauma Service Areas) and §157.123 of this title (relating to Regional Emergency Medical Services/Trauma Systems); will be administratively supported by the RAC; and will have fair and equitable representation on the board of the applicable RAC.

  (5) Multiple PCRs can meet together for the purposes of mutual collaboration.


Source Note: The provisions of this §133.203 adopted to be effective March 1, 2018, 43 TexReg 875

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