(a) One person may act in the capacity of the administrator, the clinical director, and the birth attendant provided that person meets all the minimum qualifications set out in paragraphs (2)(A) and (3)(A) of this subsection and is capable of performing all of the duties specifically stated in paragraphs (1)(B), (2)(B), and (3)(B) of this subsection. The minimum qualifications and duties for the administrator, the clinical director, the birth attendant, other clinical care providers and nonprofessional personnel of a center are as follows.
  (1) Administrator.
    (A) Qualifications.
      (i) Shall not have been employed in the last year as an administrator with another center or health care facility at the time the center or facility was cited for violations of a licensing law or rule which resulted in enforcement action taken against the center or health related facility. For purposes of this clause only, the term "enforcement action" means license revocation, suspension, emergency suspension, or denial of a license or injunction action but does not include administrative or civil penalties.
      (ii) Shall not have been convicted of a felony or misdemeanor listed in §137.22 of this title (relating to License Denial, Suspension, Probation, or Revocation).
    (B) Duties.
      (i) Administratively supervise the provision of services at the center.
      (ii) Organize and direct the center's ongoing functions.
      (iii) Employ qualified staff.
      (iv) Ensure adequate education and evaluations of staff.
      (v) Supervise non-professional staff.
      (vi) Implement an effective budgeting and accounting system which must include an auditing system for monitoring state or federal funds. The administrator shall ensure all billings or insurance claims (e.g. Medicaid) submitted are accurate.
      (vii) Ensure that issues and complaints relating to the conduct or actions by licensed health care professional(s) are addressed and, if warranted, referred and reported to the appropriate board, and that such review and action taken is documented.
      (viii) Administratively conduct or supervise the resolution(s) of complaint(s) received from clients in the delivery of their care or services received at the center.
  (2) Clinical director.
    (A) Qualifications. A licensed physician, a certified nurse-midwife (CNM), or a licensed midwife.
    (B) Duties.
      (i) Develop, implement, and monitor the clinical policies of a birthing center and ensure the adherence to these policies.
      (ii) Advise and consult with the staff of the center on all matters relating to the clinical management of all clients.
      (iii) Supervise all birth attendants and all other persons who provide direct client care.
      (iv) Ensure the accuracy of public education information materials and activities in relation to pregnancy and birth, mother and newborn care, and the center.
  (3) Birth attendant.
    (A) Qualifications. A physician, certified nurse-midwife (CNM), or a licensed midwife.
    (B) Duties. Responsible for the clinical care provided to clients of the center.
  (4) Other clinical care providers.
    (A) Qualifications. Licensed, certified or trained appropriately for the care to be provided. Prior to providing direct client care the clinical director shall verify licensure, certification or competence. Shall be certified in CPR for health care providers.
    (B) Duties. Provides care only under the supervision of a birth attendant in accordance with all laws, rules and policies appropriate to his or her professional scope of practice.
  (5) Nonprofessional staff.
    (A) Qualifications. Nonprofessional staff must be able to demonstrate the knowledge, skills, and abilities of their specified job duty within the center. This staff must be at least 16 years old.
    (B) Duties. Responsible for the provision of nonclinical services such as housekeeping, laundry, and sanitation in the operation of the center.
(b) A center shall ensure that its birth attendants meet the following requirements.
  (1) Licensed midwives must be licensed in accordance with Texas Midwifery Act, Occupations Code, Chapter 203.
  (2) Certified nurse-midwives (CNM) must maintain certification as a CNM as defined in §137.2 of this title (relating to Definitions).
  (3) Physicians must maintain current licensure as a physician as defined in §137.2 of this title.
(c) A center shall ensure that the personnel record for each employee includes:
  (1) job descriptions for all personnel providing client care;
  (2) orientation and training of all employees, volunteers, students and contractors;
  (3) an annual written evaluation of employee performance;
  (4) in-service and continuing education;
  (5) evidence of current certification of all birth attendants by the American Heart Association or the American Red Cross in basic life support and the American Academy of Pediatrics or the American Heart Association in neonatal resuscitation; and
  (6) verification of current licensure or a current copy of the license for licensed personnel.

Source Note: The provisions of this §137.34 adopted to be effective December 2, 2007, 32 TexReg 8507