The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.     
       (1) Act--Texas Birthing Center Licensing Act, Health and Safety Code, Chapter 244, relating to the licensure and regulation of centers.      
       (2) Acute postpartum period--A minimum of two hours following the delivery of the placenta and until the client is clinically stable.      
       (3) Administrator--A person who is delegated the responsibility for the implementation and proper application of policies, programs, and services established for the center.      
       (4) Admission--A client that is accepted by the center after a risk assessment is performed.      
       (5) Affiliate--With respect to an applicant or owner which is:                (A) a corporation--includes each officer, director, stockholder with a direct ownership of at least 5.0%, subsidiary, and parent company;                 (B) a limited liability company--includes each officer, member, and parent company;                 (C) an individual--includes:                    (i) the individual's spouse;                     (ii) each partnership and each partner thereof of which the individual or any affiliate of the individual is a partner; and                     (iii) each corporation in which the individual is an officer, director, or stockholder with a direct ownership of at least 5.0%;                   (D) a partnership--includes each partner and any parent company; and                 (E) a group of co-owners under any other business arrangement--includes each officer, director, or the equivalent under the specific business arrangement and each parent company.        
       (6) Applicant--The owner of a center which is applying for a license under the Act. This is the person in whose name the license will be issued.      
       (7) Birth attendant--A physician, certified nurse-midwife (CNM), or a licensed midwife.      
       (8) Center--A facility, place, or institution where a woman is scheduled to give birth. This term does not include a hospital, ambulatory surgical center, a nursing home, or the residence of the woman giving birth.      
       (9) Certified nurse-midwife (CNM)--A person who is:                (A) a registered nurse who is currently licensed under the Nursing Practice Act, Texas Occupations Code, Chapters 301, 303 and 304;                 (B) recognized as an advanced practice nurse by The Board of Nursing for the State of Texas; and                 (C) certified by the American College of Nurse-Midwives (ACNM) or ACNM Accreditation Council.        
       (10) Client--A woman who is scheduled to give birth at a center and the newborn of that birth.      
       (11) Clinical care--Direct provision of care to center clients.      
       (12) Clinical care provider--A registered nurse (RN), licensed vocational nurse (LVN), physician assistant (PA), or adult unlicensed staff person who is capable of recognizing complications and who can care for the mother and newborn by performing the minimum duties set out in §137.48(d) of this title (relating to Labor and Birth Procedures).      
       (13) Clinical director--A person who is responsible for advising and consulting with the staff of a center on all matters relating to the clinical management of all clients.      
       (14) Critical item--All surgical instruments and objects that are introduced directly into the bloodstream or into other normally sterile areas of the body.      
       (15) Decontamination--The physical and chemical process that renders an inanimate object safe for further handling.      
       (16) Department--The Department of State Health Services.      
       (17) Disinfection--The destruction or removal of vegetative bacteria, fungi, and most viruses but not necessarily spores; the process does not remove all organisms but reduces them to a level that is not harmful to health. There are three levels of disinfection:                (A) high level disinfection--kills all organisms, except high levels of bacterial spores, and is effected with a chemical germicide cleared for marketing as a sterilant by the Food and Drug Administration;                 (B) intermediate-level disinfection--kills mycobacteria, most viruses, and bacteria with a chemical germicide registered as a "tuberculocide" by the Environmental Protection Agency (EPA); and                 (C) low-level disinfection--kills some virus and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA.        
       (18) Health care facility--Any type of facility or home and community support services agency licensed (or equivalent) to provide health care in any state or certified for Medicare (Title XVIII) and Medicaid (Title XIX) participation in any state.      
       (19) Hospital--A facility that is licensed under the Texas Hospital Licensing Law, Health and Safety Code, Chapter 241 or, if exempt from licensure, certified by the United States Department of Health and Human Services as in compliance with conditions of participation for hospitals in Title XVIII, Social Security Act (42 United States Code, §§1395 et seq.).      
       (20) Initial license--The first license that is issued to an applicant indicating that the center meets all requirements of this chapter for a license.      
       (21) Licensed health care professional--An individual licensed in the State of Texas to provide specific health care services within a defined scope of practice by their licensing rules or Act.      
       (22) Licensed midwife--A person who practices midwifery and is licensed under the Texas Midwifery Act, Texas Occupations Code, Chapter 203.      
       (23) Licensed premises--The location stated or described in the application that is licensed by the department.      
       (24) Licensed vocational nurse (LVN)--A person who is currently licensed under the Nurse Practice Act, Texas Occupations Code, Chapters 301, 303, and 304, as a licensed vocational nurse.      
       (25) Low-risk pregnancy--A pregnancy that is determined by history, application of a risk assessment, and prenatal care that broadly predicts an outcome of a normal, uncomplicated pregnancy.      
       (26) Manager--The manager of the Facility Licensing Group of the Department of State Health Services or his or her designee.      
       (27) Midwife--A certified nurse-midwife (CNM) or a licensed midwife.      
       (28) Noncritical items--Items that come in contact with intact skin.      
       (29) Notarized copy--A sworn affidavit stating that attached copies are true and correct copies of the original documents.      
       (30) Person--An individual, firm, partnership, corporation, or association.      
       (31) Physician--A person who is currently licensed under the Medical Practice Act, Texas Occupations Code, Chapters 151 - 165, to practice medicine.      
       (32) Physician assistant (PA)--A person who is currently licensed under the Physician Assistant Licensing Act, Texas Occupations Code, Chapter 204, as a physician assistant.      
       (33) Physician consultant--A physician who is currently licensed under the Medical Practice Act, Texas Occupations Code, Chapters 151 - 165, to practice medicine and who consults with a center.      
       (34) Plan of correction--A written strategy for correcting a licensing violation. The plan of correction shall be developed by the facility and shall address the systems operations of the facility as the systems operations apply to the deficiency.      
       (35) Policy--A written document which describes all procedures to be followed at the facility including medical and personnel issues which is to be maintained at the licensed premises for a minimum of five years.      
       (36) Presurvey conference--A conference held with department staff and the applicant or his or her representatives to review licensure standards, survey documents, and provide consultation prior to the on-site licensure survey.      
       (37) Quality assurance--An ongoing, objective, and systematic process of monitoring, evaluating, and improving the quality, appropriateness, and effectiveness of care.      
       (38) Quality improvement--An organized, structured process that selectively identifies improvement projects to achieve improvements in products or services.      
       (39) Referral hospital--A hospital that a center has identified as capable of providing care and services to mothers or infants who require the services of a physician.      
       (40) Registered nurse (RN)--A person who is currently licensed under the Nurse Practice Act, Texas Occupations Code, Chapters 301, 303, and 304 as a registered nurse.      
       (41) Risk-assessment--A process by which application of historical, physical, and laboratory data is used for the prediction of pregnancy outcome.      
       (42) Semi-critical items--Items that come in contact with nonintact skin or mucous membranes. Semi-critical items may include respiratory therapy equipment and thermometers.      
       (43) Standards--Minimum requirements under the Act and this chapter.      
       (44) Sterile field--The operative area of the body and anything that directly contacts this area.      
       (45) Sterilization--The use of a physical or chemical procedure to destroy all microbial life, including bacterial endospores.      
       (46) Survey--A survey or investigation conducted by a representative of the department to determine if a licensee is in compliance with the statute and this chapter. A survey may be conducted onsite, by mail, by telephone, or by electronic communication methods.      
     Source Note:        The provisions of this §137.2 adopted to be effective December 2, 2007, 32 TexReg 8507