(a) Maternal Program Philosophy. Designated facilities must have a family centered philosophy. The facility environment for perinatal care must meet the physiologic and psychosocial needs of the mothers, infants, and families. Parents must have reasonable access to their infants at all times and be encouraged to participate in the care of their infants.
(b) Maternal Program Plan. The facility must develop a written maternal operational plan for the maternal program that includes a detailed description of the scope of services and clinical resources available for all maternal patients and families. The plan will define the maternal patient population evaluated, treated, transferred, or transported by the facility consistent with clinical guidelines based on current standards of maternal practice ensuring the health and safety of patients.
(1) The written Maternal Program Plan must be reviewed and approved by Maternal Program Oversight and be submitted to the facility's governing body for review and approval. The governing body must ensure that the requirements of this section are implemented and enforced.
(2) The written Maternal Program Plan must include, at a minimum:
(3) The facility must have a documented QAPI Plan. The maternal program must measure, analyze, and track quality indicators and other aspects of performance that the facility adopts or develops that reflect processes of care and is outcome based.
(c) Medical Staff. The facility must have an organized maternal program that is recognized by the facility's medical staff and approved by the facility's governing body.
(1) The credentialing of the maternal medical staff must include a process for the delineation of privileges for maternal care.
(2) The maternal medical staff must participate in ongoing staff and team-based education and training in the care of the maternal patient.
(d) Medical Director. There must be an identified MMD and an identified Transport Medical Director (TMD) if the facility has its own transport program. The MMD and TMD must be credentialed by the facility for treatment of maternal patients and have their responsibilities and authority defined in a job description. The MMD is responsible for the provision of maternal care services and:
(1) examining qualifications of medical staff requesting maternal privileges and making recommendations to the appropriate committee for such privileges;
(2) assuring maternal medical staff competency in managing obstetrical emergencies, complications and resuscitation techniques;
(3) monitoring maternal patient care from transport if applicable, to admission, stabilization, operative intervention(s) if applicable, through discharge, and inclusive of the QAPI Plan;
(4) participating in ongoing maternal staff and team-based education and training in the care of the maternal patient;
(5) overseeing the inter-facility maternal transport;
(6) collaborating with the MPM in areas to include developing or revising policies, procedures and guidelines, assuring medical staff and personnel competency, education and training; and the QAPI Plan;
(7) frequently leading the maternal QAPI meetings with the MPM and participating in Maternal Program Oversight and other maternal meetings as appropriate;
(8) ensuring that the QAPI Plan is specific to maternal and fetal care, is ongoing, data-driven and outcome-based;
(9) participating as a clinically active and practicing physician in maternal care at the facility where medical director services are provided;
(10) maintaining active staff privileges as defined in the facility's medical staff bylaws; and
(11) developing collaborative relationships with other MMD(s) of designated facilities within the applicable Perinatal Care Region.
(e) MPM. The facility must identify a MPM who has the authority and oversight responsibilities written in his or her job description for the provision of maternal services through all phases of care, including discharge and identifying variances in care for inclusion in the QAPI Plan and:
(1) be a registered nurse with perinatal experience;
(2) be a clinically active and practicing registered nurse participating in maternal care at the facility where program manager services are provided;
(3) has the authority and responsibility to monitor the provision of maternal patient care services from admission, stabilization, operative intervention(s) if applicable, through discharge, and inclusive of the QAPI Plan;
(4) collaborates with the MMD in areas to include developing or revising policies, procedures and guidelines; assuring staff competency, education, and training and the QAPI Plan;
(5) frequently leads the maternal QAPI meetings and participates in Maternal Program Oversight and other maternal meetings as appropriate;
(6) ensures that the QAPI Plan is specific to maternal and fetal care, is ongoing, data-driven and outcome based, including telehealth/telemedicine utilization, when used; and
(7) develops collaborative relationships with other MPM(s) of designated facilities within the applicable Perinatal Care Region.
Source Note: The provisions of this §133.205 adopted to be effective March 1, 2018, 43 TexReg 875; amended to be effective January 8, 2023, 47 TexReg 8986