Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 133 - HOSPITAL LICENSING
Subchapter K - HOSPITAL LEVEL OF CARE DESIGNATIONS FOR MATERNAL CARE
Section 133.207 - Maternal Designation Level II

(1) 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

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

(1) is a family medicine physician, an obstetrics and gynecology physician, or maternal fetal medicine physician, all with obstetrics training and experience, and with privileges in maternal care;

(2) demonstrates administrative skills and oversight of the Quality Assessment and Performance Improvement (QAPI) Plan; and

(3) has completed annual continuing education specific to maternal care, including complicated conditions.

(1) Triage and assessment of all patients admitted to the perinatal service.

(2) Provide care for pregnant patients with the capability to detect, stabilize, and initiate management of unanticipated maternal-fetal or maternal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a higher level of neonatal or maternal care.

(3) An obstetrics and gynecology physician or family medicine physician with obstetrics training and experience, including operative training, and with maternal privileges, must be available at all times and arrive at the patient bedside within 30 minutes of an urgent request. Facilities that utilize family medicine physicians in this role must have a written plan for responding to obstetrical emergencies that require services or procedures outside the scope of privileges granted to the family physician, and regularly monitor outcomes in their QAPI Plan.

(4) A board-certified or board-eligible maternal fetal medicine physician must be available at all times for consultation.

(5) Medical and surgical physicians must be available at all times and arrive at the patient bedside within 30 minutes of an urgent request.

(6) Specialists, including behavioral health, must be available at all times for consultation appropriate to the patient population served.

(7) Ensure that a qualified physician or certified nurse midwife with appropriate physician back-up is available to attend all deliveries or other obstetrical emergencies.

(8) The primary provider caring for a pregnant or postpartum patient who is a family medicine physician with obstetrics training and experience, obstetrics and gynecology physician, maternal fetal medicine physician, or a certified nurse midwife, physician assistant or nurse practitioner with appropriate physician back-up, whose credentials have been reviewed by the MMD and is on-call:

(9) Certified nurse midwives, physician assistants and nurse practitioners who provide care for maternal patients:

(10) An on-call schedule of providers, back-up providers, and provision for patients without a physician must be readily available to facility and maternal staff and posted on the labor and delivery unit.

(11) Ensure that the physician providing back-up coverage must arrive at the patient bedside within 30 minutes of an urgent request.

(12) The appropriate anesthesia, laboratory, pharmacy, radiology, respiratory therapy, ultrasonography and blood bank services must be available on a 24-hour basis as described in § 133.41 of this title (relating to Hospital Functions and Services) respectively.

(13) Obstetrical Services.

(14) Resuscitation. The facility must have written policies and procedures specific to the facility for the stabilization and resuscitation of the pregnant or postpartum patient based on current standards of professional practice. The facility:

(15) The facility must have a written hospital preparedness and management plan for patients with placenta accreta spectrum disorder who are undiagnosed until delivery, including educating hospital and medical staff who may be involved in the treatment and management of placenta accreta spectrum disorder about risk factors, diagnosis, and management.

(16) The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of:

(17) The facility must have nursing leadership and staff with training and experience in the provision of maternal nursing care who must coordinate with respective neonatal services.

(18) Perinatal Education. A registered nurse with experience in maternal care, including moderately complex and ill obstetric patients, must provide the supervision and coordination of staff education. Perinatal education for high risk events must be provided at frequent intervals to prepare medical, nursing, and ancillary staff for these emergencies.

(19) Support personnel with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times.

(20) Social services, pastoral care and bereavement services must be provided as appropriate to meet the needs of the patient population served.

(21) Dietician or nutritionist available with appropriate training and experience for population served in compliance with the requirements in § 133.41 of this title.