| (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.
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