| (a) The department reviews the applicant documents
and approves the appropriate level of facility designation.
(b) A 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 must be considered separately for
designation and the department approves the designation level for
each location based on the location's ability to demonstrate designation
criteria are met.
(d) The department determines requirements for the
levels of maternal designation. Facilities seeking Levels II, III,
and IV maternal designation must meet department-approved requirements
validated by a department-approved survey organization.
(e) Facilities seeking Level I maternal designation
must submit a self-survey and attest to meeting department-approved
requirements.
(f) The four levels of maternal designation are:
(1) Level I (Basic Care). The Level I maternal designated
facility must:
(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 must:
(A) provide care for pregnant and postpartum patients
with medical, surgical, 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 must:
(A) provide care for pregnant and postpartum patients
with low risk conditions to significant complex medical, surgical,
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 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 related to trends identified
through the QAPI Plan, specific requests, and system needs to lower
level designated facilities, and as appropriate and applicable, to
non-designated facilities, birthing centers, independent midwife practices,
and prehospital providers.
(4) Level IV (Comprehensive Care). The Level IV maternal
designated facility must:
(A) provide comprehensive care for pregnant and postpartum
patients with low risk conditions to the most complex medical, surgical
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 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 a placenta accreta spectrum disorder multidisciplinary
care team with expertise to complete risk factor screening, evaluation,
diagnosis, consultation, and management of patients with anticipated
or unanticipated placenta accreta spectrum disorder, including postpartum
care;
(G) have skilled personnel with documented training,
competencies, and annual continuing education, specific for the patient
population served;
(H) facilitate transports; and
(I) provide outreach education related to trends identified
through the QAPI Plan, specific requests, and system needs to lower
level designated facilities, and as appropriate and applicable, to
non-designated facilities, birthing centers, independent midwife practices,
and prehospital providers.
(g) Facilities seeking maternal designation must undergo
an on-site or virtual survey as outlined in this section and:
(1) are responsible for scheduling a maternal designation
survey through a department-approved survey organization;
(2) must notify the department of the maternal designation
survey date;
(3) are responsible for expenses associated with the
maternal designation survey;
(4) must not accept surveyors with any conflict of
interest; and
(5) must provide the survey team access to records
and documentation regarding the QAPI Plan and process related to maternal
patients.
(h) If a conflict of interest is present for a facility
seeking maternal designation, the facility must decline the assigned
surveyor through the surveying organization. A conflict of interest
exists when a surveyor has a direct or indirect financial, personal,
or other interest which would limit or could reasonably be perceived
as limiting the surveyor's ability to serve in the best interest of
the public. The conflict of interest may include a surveyor that personally
trained a key member of the facility's leadership in residency or
fellowship, collaborated with a key member of the facility's leadership
professionally, participated in a designation consultation with the
facility, had a previous working relationship with the facility or
facility leaders, or conducted a designation survey for the facility
within the past four years.
(1) Surveyors cannot be from the same PCR or TSA region
or a contiguous region of the facility's location.
(2) Designation site survey summary and record reviews
performed by a surveyor with an identified conflict of interest may
not be accepted by the department.
(i) The survey team evaluates the facility's evidence
that department-approved designation requirements are met and documents
all requirements that are not met in the maternal designation site
survey and medical record reviews.
|
