reglab/statecodes huggingface dataset:
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 133.203 - General Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
				  reviews the applicant documents and approves the appropriate level of facility
				  designation.
(b) A 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 must be
				  considered separately for designation and the department approves the
				  designation level for each location based on the location's ability to
				  demonstrate designation criteria are met.
(d) The department determines requirements
				  for the levels of maternal designation. Facilities seeking Levels II, III, and
				  IV maternal designation must meet department-approved requirements validated by
				  a department-approved survey organization.
(e) Facilities seeking Level I maternal
				  designation must submit a self-survey and attest to meeting department-approved
				  requirements.
(f) The four levels
				  of maternal designation are:
(1) Level I
				  (Basic Care). The Level I maternal designated facility must:
(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.
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 133.204 - Designation Process

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility
				  seeking maternal designation or renewal of designation must submit a completed
				  application packet.
(1) The completed
				  application packet includes:
(A) an accurate
				  and complete maternal designation application for the requested level of
				  designation;
(B) a completed
				  maternal attestation and self-survey report for Level I applicants or the
				  documented maternal designation site survey summary that validates that
				  department-approved designation requirements are met and the medical record
				  reviews for Levels II, III, and IV applicants, submitted to the department no
				  later than 90 days after the maternal designation site survey date;
(C) If the facility has three or more
				  department-approved designation requirements that are defined as not met, the
				  facility must contact the department's designation unit within 10 business days
				  to discuss the Plan of Correction (POC).
(D) if required by the department, a POC that
				  addresses all designation requirements defined as "not met" in the maternal
				  designation site survey summary. The POC must include:
(i) a statement of the cited designation
				  requirement not met;
(ii) a
				  statement describing the corrective action taken by the facility seeking
				  maternal designation to meet the requirement;
(iii) the title of the individuals
				  responsible for ensuring the corrective actions are implemented;
(iv) the date the corrective actions were
				  implemented;
(v) how the corrective
				  actions will be monitored; and
(vi)
				  documented evidence that the POC was implemented within 90 days of the
				  designation survey;
(E)
				  written evidence of annual participation in the applicable PCRs; and
(F) any subsequent documents submitted by the
				  date requested by the department.
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 133.206 - Maternal Designation Level I

Current through Reg. 49, No. 28; July 12, 2024
(a) Level I (Basic
				  Care). The Level I maternal designated facility must:
(1) 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
(2) have skilled
				  personnel with documented training, competencies, and annual continuing
				  education specific for the patient population served.
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

Current through Reg. 49, No. 28; July 12, 2024
(a) Level II
				  (Specialty Care). The Level II maternal designated facility must:
(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.
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 133.208 - Maternal Designation Level III

Current through Reg. 49, No. 28; July 12, 2024
(a) A Level III
				  (Subspecialty Care). The Level III maternal designated facility must:
(1) provide care for pregnant and postpartum
				  patients with low risk conditions to significant complex medical, surgical or
				  obstetrical conditions that present a high risk of maternal morbidity or
				  mortality;
(2) ensure access to
				  consultation to a full range of medical and maternal subspecialists, surgical
				  specialists, and behavioral health specialists;
(3) ensure capability to perform major
				  surgery on-site;
(4) have
				  physicians with critical care training available at all times to actively
				  collaborate with Maternal Fetal Medicine physicians or Obstetrics and
				  Gynecology Physicians with obstetrics training and privileges in maternal
				  care;
(5) have skilled personnel
				  with documented training, competencies, and annual continuing education,
				  specific for the population served;
(6) facilitate transports; and
(7) provide outreach education related to
				  trends identified through the QAPI Plan, specific requests, and system needs to
				  lower level designated facilities, and as appropriate and applicable, to
				  non-designated facilities, birthing centers, independent midwife practices, and
				  prehospital providers.
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 133.209 - Maternal Designation Level IV

Current through Reg. 49, No. 28; July 12, 2024
(a) A Level IV
				  (Comprehensive Care). The Level IV maternal designated facility must:
(1) provide comprehensive care for pregnant
				  and postpartum patients with low risk conditions to the most complex medical,
				  surgical or obstetrical conditions and their fetuses, that present a high risk
				  of maternal morbidity or mortality;
(2) ensure access to on-site consultation to
				  a comprehensive range of medical and maternal subspecialists, surgical
				  specialists and behavioral health specialists;
(3) ensure capability to perform major
				  surgery on-site;
(4) have
				  physicians with critical care training available at all times to actively
				  collaborate with Maternal Fetal Medicine physicians or Obstetrics and
				  Gynecology physicians with obstetrics training, experience and privileges in
				  maternal care;
(5) 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;
(6) have a placenta
				  accreta spectrum disorder multidisciplinary care team with expertise to
				  complete risk factor screening, evaluation, diagnosis, consultation, and
				  management of patients with anticipated or unanticipated placenta accreta
				  spectrum disorder, including postpartum care;
(7) have skilled personnel with documented
				  training, competencies, and annual continuing education, specific for the
				  patient population served;
(8)
				  facilitate transports; and
(9)
				  provide outreach education related to trends identified through the QAPI Plan,
				  specific requests, and system needs to lower level designated facilities, and
				  as appropriate and applicable, to non-designated facilities, birthing centers,
				  independent midwife practices, and prehospital providers.
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 133.210 - Survey Team

Current through Reg. 49, No. 28; July 12, 2024
(a) The survey team
				  composition must be as follows:
(1) Level I
				  facilities maternal program staff must conduct a self-survey, documenting the
				  findings on the approved department survey form. The department may
				  periodically require validation of the survey findings, by an on-site review
				  conducted by department staff.
(2)
				  Level II facilities must be surveyed by a multidisciplinary team that includes
				  at a minimum one obstetrics and gynecology physician and one maternal nurse
				  who:
(A) have completed a survey training
				  course;
(B) have observed a minimum
				  of one maternal survey;
(C) are
				  currently active in the management of maternal patients and active in the
				  maternal QAPI Plan and process at a facility providing the same or higher level
				  of maternal care; and
(D) meet the
				  criteria outlined in the department survey guidelines.
(3) Level III facilities must be surveyed by
				  a multidisciplinary team that includes at a minimum, one obstetrics and
				  gynecology physician or maternal fetal medicine physician and one maternal
				  nurse, who:
(A) have completed a survey
				  training course;
(B) have observed
				  a minimum of one maternal survey;
(C) are currently active in the management of
				  maternal patients and active in the maternal QAPI Plan and process at a
				  facility providing the same or higher level of maternal care; and
(D) meet the criteria outlined in the
				  department survey guidelines.
(4) Level III facilities that serve as
				  referral centers for placenta accreta spectrum disorder, must have a survey
				  team that includes a maternal fetal medicine physician and a maternal nurse
				  from a Level IV facility.
(5) Level
				  IV facilities must be surveyed by a multidisciplinary team that includes at a
				  minimum, one obstetrics and gynecology physician, a maternal fetal medicine
				  physician, and one maternal nurse, who:
(A)
				  have completed a survey training course;
(B) have observed a minimum of one maternal
				  survey;
(C) are currently active in
				  the management of maternal patients and active in the maternal QAPI plan and
				  process at a facility providing Level IV maternal care; and
(D) meet the criteria outlined in the
				  department survey guidelines.
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 133.211 - Perinatal Care Regions (PCRs)

Current through Reg. 49, No. 28; July 12, 2024
(a) The maternal
				  medical director and maternal program manager must have evidence of annual
				  participation in the PCR meetings, self-assessment, system development,
				  perinatal activities, and collaboratives.
(b) The PCR must consider and facilitate
				  transfer agreements through regional coordination.
(c) The PCR must coordinate regional
				  perinatal system QAPI reviews.
(d)
				  The PCRs must not restrict patient referrals.
(e) The PCR integrates with the Regional
				  Advisory Council (RAC) system plans to ensure there is a written perinatal
				  system plan specific to the regional area utilizing the RAC criteria and
				  self-assessment tools.
(f) The PCRs
				  are administratively supported by the RAC and must have fair and equitable
				  representation on the board of the applicable RAC.
(g) Each PCR is responsible for defining data
				  needs and regional collaboratives.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 133 - HOSPITAL LICENSING › Subchapter L - CENTERS OF EXCELLENCE FOR FETAL DIAGNOSIS AND THERAPY › Section 133.221 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to implement Health and
					 Safety Code, Chapter 32, Subchapter D, Centers of Excellence for Fetal
					 Diagnosis and Therapy designation, to achieve healthy fetal outcomes in this
					 state.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 133 - HOSPITAL LICENSING › Subchapter L - CENTERS OF EXCELLENCE FOR FETAL DIAGNOSIS AND THERAPY › Section 133.222 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1)
				  Antenatal--Occurring or existing before birth, referring to both the care of
				  the woman during pregnancy and the growth and development of the fetus.
(2) Available--Relating to staff
				  who can be contacted for consultation at all times without delay.
(3) CEFDT--A facility designated as a Center
				  of Excellence for Fetal Diagnosis and Therapy.
(4) Commission--The Health and Human Services
				  Commission.
(5) Department--The
				  Department of State Health Services.
(6) Designation--A formal recognition by the
				  department of a facility's fetal diagnosis and therapy care capabilities and
				  commitment, for a period of three years.
(7) Executive Commissioner--The Executive
				  Commissioner of the Health and Human Services Commission.
(8) Fetal--Of, relating to, or being a fetus.
(9) CEFDTMD--CEFDT Medical
				  Director.
(10) CEFDTPM--CEFDT
				  Program Manager.
(11)
				  Innovation--A new method of investigation or an experiment undertaken to
				  benefit an individual patient.
(12) Level I evidence-based metrics--Evidence
				  from a systematic review of all relevant randomized controlled trials (RCTs) or
				  evidence-based clinical practice guidelines from major national perinatal
				  organizations, based on systematic reviews of RCTs.
(13) Maternal--Pertaining to the pregnant
				  patient or mother.
(14)
				  Maternal-Fetal Patient--Pertaining to the pregnant patient and her fetus(es).
(15) Office--Office of Emergency
				  Medical Services (EMS)/Trauma Systems.
(16) On-site--At the facility and able to
				  rapidly arrive at the patient bedside for urgent requests.
(17) PCR--Perinatal Care Region.
(18) Perinatal--Of, relating to, or being the
				  period around childbirth, especially the five months before and one month after
				  birth.
(19) Research--An
				  investigation or experiment undertaken to create generalized knowledge about a
				  particular subject.
(20)
				  Urgent--Requiring immediate action or attention.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 133 - HOSPITAL LICENSING › Subchapter L - CENTERS OF EXCELLENCE FOR FETAL DIAGNOSIS AND THERAPY › Section 133.224 - Designation Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Designation
				  application packet. The applicant shall submit the packet that includes the
				  following documents, to the Office of EMS/Trauma Systems (office) within 120
				  days of the facility's verification for maternal-fetal surgical care:
(1) an accurate and complete designation
				  application form for designation, including full payment of the designation fee
				  as listed in subsection (d) of this section;
(2) evidence of current Level IV Neonatal
				  designation;
(3) evidence of
				  current Level IV Maternal designation;
(4) evidence of current verification for
				  maternal-fetal surgical care, including patient case reviews;
(5) evidence of current verification from the
				  American College of Surgeons as a Level I Children's Surgery Center, including
				  patient case reviews;
(6) a letter
				  of support from the facility's governing board supporting provisions for the
				  collection and evaluation of short-term and long-term outcomes;
(7) evidence of participation in the CEFDT
				  meetings twice a year;
(8)
				  evidence of outcomes posted for public access; and
(9) any subsequent documents requested by the
				  office.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 133 - HOSPITAL LICENSING › Subchapter L - CENTERS OF EXCELLENCE FOR FETAL DIAGNOSIS AND THERAPY › Section 133.225 - Program Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A CEFDT
				  shall provide patient-centered and family-centered health care. The environment
				  for maternal-fetal care shall comprehensively meet the physiologic and
				  psychosocial needs of the pregnant patient, their infants, and
				  families.
(b) Program Plan. The
				  CEFDT shall develop a written plan of an organized program that includes a
				  detailed description of the scope of services available to the maternal-fetal
				  patient, defines the maternal-fetal patient population evaluated and/or treated
				  by the CEFDT, which is consistent with accepted professional standards of
				  practice for maternal-fetal care, and ensures the health and safety of
				  patients.
(1) The written plan and the
				  program policies and procedures shall be reviewed and approved by the
				  facility's governing body. The governing body shall ensure that the
				  requirements of this section are implemented and enforced.
(2) The written program plan shall include,
				  at a minimum:
(A) program policies and
				  procedures that are:
(i) based upon current
				  standards of fetal diagnosis and therapy practice; and
(ii) adopted, implemented and enforced for
				  the maternal-fetal services it provides;
(B) a periodic review and revision schedule
				  for all maternal-fetal care policies and procedures;
(C) a Quality Assessment/Performance
				  Improvement (QAPI) Program as described in §
												133.41
				  of this title (relating to Hospital Functions and Services). The CEFDT shall
				  demonstrate that the QAPI Program evaluates the provision of maternal-fetal
				  care on an ongoing basis, identify opportunities for improvement, develop and
				  implement improvement plans, and evaluate the implementation until a resolution
				  is achieved. The QAPI Program shall measure, analyze, and track quality
				  indicators or other aspects of performance that the CEFDT adopts or develops
				  that reflect processes of care and is outcome based. Aggregate patient data
				  must be continuously reviewed for trends. QAPI data must be submitted to the
				  department as requested;
(D)
				  appropriate follow up for all infants through an established referral
				  process;
(E) short-term and
				  long-term outcomes of the pregnant patient and her fetus(es) after fetal
				  interventions will be monitored by the CEFDT;
(F) requirements for minimal credentials for
				  all staff participating in the care of maternal-fetal patients;
(G) provisions for providing continuing staff
				  education, including annual competency and skills assessment that is
				  appropriate for the patient population served; and
(H) procedures to ensure the availability of
				  all necessary equipment and services to provide the appropriate level of care
				  and support of the patient population served.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 133 - HOSPITAL LICENSING › Subchapter L - CENTERS OF EXCELLENCE FOR FETAL DIAGNOSIS AND THERAPY › Section 133.226 - Surveyors

Current through Reg. 49, No. 28; July 12, 2024
(a) A CEFDT shall
				  be surveyed by a team, approved by the office, which is multi-disciplinary and
				  includes at a minimum one board certified physician that is active in the
				  management of maternal-fetal patients and/or performs fetal interventions; and
				  a nurse active in the management of maternal-fetal patients, at a facility
				  providing the same level of maternal-fetal care. An additional surveyor may be
				  requested by the facility or at the discretion of the office.
(b) Office-credentialed surveyors must meet
				  the following criteria:
(1) have at least
				  three years of experience in the care of maternal-fetal patients and/or fetal
				  interventions;
(2) be currently
				  employed and clinically practicing in the coordination of care for
				  maternal-fetal patients and fetal interventions;
(3) have direct experience in the preparation
				  for and successful completion of a Centers of Excellence for Fetal Diagnosis
				  and Therapy verification and/or designation;
(4) have successfully completed an
				  office-approved Centers of Excellence for Fetal Diagnosis and Therapy site
				  surveyor course and be successfully re-credentialed every four years; and
(5) have current credentials as:
(A) a registered nurse with maternal-fetal
				  experience who has successfully completed an office-approved site survey
				  internship; or
(B) a physician who
				  is board certified in the respective specialty, and has successfully completed
				  an office-approved site survey internship.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.1 - Scope and Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of
				  these sections is to implement Health and Safety Code, Chapter 243, which
				  requires ambulatory surgical centers to be licensed by the Department of State
				  Health Services.
(b) These sections
				  provide minimum standards for ambulatory surgical center licenses and
				  procedures for granting, denying, suspending, and revoking a license and
				  licensure fees. The sections under this subchapter primarily cover the
				  licensing procedures and standards for operation, and the remaining sections of
				  this chapter primarily cover the requirements concerning construction design
				  and the life safety code.
(c) The
				  standards pertaining to the construction and design, the qualifications of the
				  professional staff and other personnel, the equipment essential to the health
				  and welfare of the patients, sanitary and hygienic conditions, and the quality
				  assurance program may not exceed the minimum standards for certification under
				  the Social Security Act, Title XVIII, 42 United States Code (USC),
				  §§1395 et seq.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in these sections,
					 shall have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Act--Texas Ambulatory
				  Surgical Center Licensing Act, Health and Safety Code, Chapter 243.
(2) Action plan--A written document that
				  includes specific measures to correct identified problems or areas of concern;
				  identifies strategies for implementing system improvements; and includes
				  outcome measures to indicate the effectiveness of system improvements in
				  reducing, controlling or eliminating identified problem areas.
(3) Administrator--A person who is a
				  physician, is a registered nurse, has a baccalaureate or postgraduate degree in
				  administration or a health-related field, or has one year of administrative
				  experience in a health care setting.
(4) Advanced practice registered nurse
				  (APRN)--A registered nurse approved by the Texas Board of Nursing to practice
				  as an advanced practice registered nurse in Texas. The term includes a nurse
				  practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist.
				  The term is synonymous with "advanced nurse practitioner."
(5) Ambulatory Surgical Center (ASC)--A
				  facility that primarily provides surgical services to patients who do not
				  require overnight hospitalization or extensive recovery, convalescent time or
				  observation. The planned total length of stay for an ASC patient shall not
				  exceed 23 hours. Patient stays of greater than 23 hours shall be the result of
				  an unanticipated medical condition and shall occur infrequently. The 23-hour
				  period begins with the induction of anesthesia.
(6) Autologous blood units--Units of blood or
				  blood products derived from the recipient.
(7) Available--Able to be physically present
				  in the facility to assume responsibility for the delivery of patient care
				  services within five minutes.
(8)
				  Certified registered nurse anesthetist (CRNA)--A registered nurse who has
				  current certification from the Council on Certification of Nurse Anesthetists
				  and who is currently authorized to practice as an advanced practice registered
				  nurse by the Texas Board of Nursing.
(9) Change of ownership--
(A) a sole proprietor who transfers all or
				  part of the ASC's ownership to another person or persons;
(B) the removal, addition, or substitution of
				  a person or persons as a general, managing, or controlling partner in an ASC
				  owned by a partnership and the tax identification number of that ownership
				  changes; or
(C) a corporation that
				  transfers all or part of the corporate stock which represents the ASC's
				  ownership to another person or persons and the tax identification number of
				  that ownership changes.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.3 - Fees

Current through Reg. 49, No. 28; July 12, 2024
(a) Initial license
				  fee. The fee for an initial license (includes change of ownership or
				  relocation) is $5,200. The license term is two years.
(b) Renewal license fee. The fee for a
				  renewal license is $5,200. The license term is two years.
(c) Official submission. The department shall
				  not consider an application as officially submitted until the applicant pays
				  the application fee and submits the application form.
(d) Nonrefundable. Fees paid to the
				  department are not refundable.
(e)
				  Payment of fees. All fees shall be paid to the Department of State Health
				  Services.
(f) Fee schedule review.
				  The department shall make periodic reviews of its fee schedule and make any
				  adjustments necessary to provide funds to meet its expenses without creating an
				  unnecessary surplus. Such adjustments shall be through section
				  amendments.
(g) Other fees. The
				  department is authorized to collect subscription and convenience fees, in
				  amounts determined by the TexasOnline Authority, to recover costs associated
				  with application and renewal application processing through TexasOnline, in
				  accordance with Government Code, §
										2054.111.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.5 - Patient Rights

Current through Reg. 49, No. 28; July 12, 2024
(a) Patients shall
				  be treated with respect, consideration, and dignity.
(b) Patients shall be provided appropriate
				  privacy.
(c) Patient records shall
				  be treated confidentially and, except when authorized by law, patients shall be
				  given the opportunity to approve or refuse their release.
(d) Patients shall be provided, to the degree
				  known, appropriate information concerning their diagnosis, treatment, and
				  prognosis. When it is medically inadvisable to give such information to a
				  patient, the information shall be provided to a person designated by the
				  patient or to a legally authorized person.
(e) Patients shall be given the opportunity
				  to participate in decisions involving their health care, except when such
				  participation is contraindicated for medical reasons.
(f) Information shall be available to
				  patients and staff concerning:
(1) patient
				  rights, including those specified in subsections (a) - (e) of this
				  section;
(2) patient conduct and
				  responsibilities;
(3) services
				  available at the ambulatory surgical center (ASC);
(4) provisions for after-hours and emergency
				  care;
(5) fees for
				  services;
(6) payment
				  policies;
(7) patient's right to
				  refuse to participate in experimental research; and
(8) methods for expressing complaints and
				  suggestions to the ASC.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.6 - Administration

Current through Reg. 49, No. 28; July 12, 2024
(a) Administrative
				  policies, procedures, and controls shall be established and implemented to
				  assure the orderly and efficient management of the ambulatory surgical center
				  (ASC). Administrative responsibilities shall include, but are not limited to:
(1) enforcing policies delegated by the
				  governing body;
(2) employing
				  qualified management personnel;
(3)
				  long-range and short-range planning for the needs of the ASC, as determined by
				  the governing body;
(4) using
				  methods of communicating and reporting, designed to assure the orderly flow of
				  information within the ASC;
(5)
				  controlling the purchase, maintenance, and distribution of the equipment,
				  materials, and facilities of the ASC;
(6) establishing lines of authority,
				  accountability, and supervision of personnel;
(7) establishing controls relating to the
				  custody of the official documents of the ASC; and
(8) maintaining the confidentiality,
				  security, and physical safety of data on patients and staff.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.7 - Quality of Care

Current through Reg. 49, No. 28; July 12, 2024
(a) All health care
				  practitioners shall have the necessary and appropriate training and skills to
				  deliver the services provided by the ambulatory surgical center
				  (ASC).
(b) Health care
				  practitioners shall practice in accordance with applicable state law and
				  conform to the standards and ethics of their professions.
(c) Patient care responsibilities shall be
				  delineated in accordance with recognized standards of practice.
(d) There shall be qualified medical
				  personnel available for emergency treatment whenever there is a patient in the
				  ASC who has received services.
(e)
				  The provision of quality health care services shall be demonstrated by at least
				  the following:
(1) accessible and available
				  health services;
(2) appropriate
				  and timely diagnostic procedures;
(3) treatment that is consistent with
				  clinical impression or working diagnosis;
(4) appropriate and timely
				  consultation;
(5) absence of
				  clinically unnecessary diagnostic or therapeutic procedures;
(6) provision for services when the ASC is
				  not open;
(7) appropriate,
				  accurate, and complete medical record entries; and
(8) adequate transfer of information when
				  patients are transferred to and from other health care providers.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.9 - Medical Records

Current through Reg. 49, No. 28; July 12, 2024
(a) The ambulatory
				  surgical center (ASC) shall develop and maintain a system for the collection,
				  processing, maintenance, storage, retrieval, and distribution of patient's
				  medical records.
(b) An individual
				  medical record shall be established for each person receiving care.
(c) All clinical information relevant to a
				  patient shall be readily available to health care practitioners involved in the
				  care of that patient.
(d) Except
				  when otherwise required by law, any record that contains clinical, social,
				  financial, or other data on a patient shall be strictly confidential and shall
				  be protected from loss, tampering, alteration, destruction, and unauthorized or
				  inadvertent disclosure.
(e) A
				  person shall be designated to be in charge of medical records whose
				  responsibilities include, but are not limited to:
(1) the confidentiality, security, and safe
				  storage of medical records;
(2) the
				  timely retrieval of individual medical records upon request;
(3) the specific identification of each
				  patient's medical record;
(4) the
				  supervision of the collection, processing, maintenance, storage, retrieval, and
				  distribution of medical records; and
(5) the maintenance of a predetermined
				  organized medical record format.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.10 - Facilities and Environment

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  ambulatory surgical center (ASC) shall have the necessary personnel, equipment,
				  and procedures to handle medical emergencies that may arise in connection with
				  services sought or provided. At a minimum, the ASC shall provide:
(1) periodic instruction of all personnel in
				  the proper use of safety, emergency, and fire-extinguishing
				  equipment;
(2) procedures,
				  including adequate surveillance techniques, that minimize sources and
				  transmission of infections;
(3) a
				  comprehensive emergency plan to address internal and external emergencies,
				  including:
(A) a provision for the safe
				  evacuation of patients during an internal emergency, especially patients who
				  have difficulty walking;
(B) a
				  provision for the most efficient use of available facilities and services
				  during an external emergency; and
(C) a requirement for at least four drills a
				  year of the internal emergency plan.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.11 - Anesthesia and Surgical Services

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Anesthesia services.
(1) Anesthesia services
				  provided in the ambulatory surgical center (ASC) shall be limited to those that
				  are approved by the governing body, which may include the following.
(A) Topical anesthesia--An anesthetic agent
				  applied directly or by spray to the skin or mucous membranes, intended to
				  produce transient and reversible loss of sensation to the circumscribed
				  area.
(B) Local
				  anesthesia--Administration of an agent that produces a transient and reversible
				  loss of sensation to a circumscribed portion of the body.
(C) Regional anesthesia--Anesthetic injected
				  around a single nerve, a network of nerves, or vein that serves the area
				  involved in a surgical procedure to block pain.
(D) Minimal sedation (anxiolysis)--A
				  drug-induced state during which patients respond normally to verbal commands.
				  Although cognitive function and coordination may be impaired, ventilatory and
				  cardiovascular functions are unaffected.
(E) Moderate sedation/analgesia ("conscious
				  sedation")--A drug-induced depression of consciousness during which patients
				  respond purposefully to verbal commands, either alone or accompanied by light
				  tactile stimulation. No interventions are required to maintain a patent airway,
				  and spontaneous ventilation is adequate. Cardiovascular function is usually
				  maintained. (Reflex withdrawal from a painful stimulus is NOT considered a
				  purposeful response.)
(F) Deep
				  sedation/analgesia--A drug-induced depression of consciousness during which
				  patients cannot be easily aroused but respond purposefully following repeated
				  or painful stimulation. The ability to independently maintain ventilatory
				  function may be impaired. Patients may require assistance in maintaining a
				  patent airway, and spontaneous ventilation may be inadequate. Cardiovascular
				  function is usually maintained. (Reflex withdrawal from a painful stimulus is
				  NOT considered a purposeful response.)
(G) General anesthesia--A drug-induced loss
				  of consciousness during which patients are not arousable, even by painful
				  stimulation. The ability to independently maintain ventilatory function is
				  often impaired. Patients often require assistance in maintaining a patent
				  airway, and positive pressure ventilation may be required because of depressed
				  spontaneous ventilation or drug-induced depression of neuromuscular function.
				  Cardiovascular function may be impaired.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.12 - Pharmaceutical Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The ambulatory
				  surgical center (ASC) shall provide drugs and biologicals in a safe and
				  effective manner in accordance with professional practices and shall be in
				  compliance with all state and federal laws and regulations. The ASC shall be
				  licensed as required by the Texas State Board of Pharmacy and comply with 22
				  Texas Administrative Code, § 291.76(relating to Class C Pharmacies Located
				  in a Freestanding Ambulatory Surgical Center).
(b) Pharmaceutical services may be made
				  available by the ASC through a contractual agreement and shall be provided in
				  accordance with the same ethical and professional practices and legal
				  requirements that would be required if such services were provided directly by
				  the ASC.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.13 - Pathology and Medical Laboratory Services

Current through Reg. 49, No. 28; July 12, 2024
Pathological and clinical services shall be provided or
					 made available when appropriate to meet the needs of the patients and
					 adequately support the ambulatory surgical center's (ASC's) clinical
					 capabilities.
(1) Pathology and
				  clinical laboratory services shall include, but are not limited to:
(A) conducting laboratory procedures that are
				  appropriate to the needs of the patients;
(B) performing tests in a timely
				  manner;
(C) distributing test
				  results within 24 hours after completion of a test and maintaining a copy of
				  the results in the laboratory; and
(D) performing and documenting appropriate
				  quality assurance procedures, including, but not limited to, calibrating
				  equipment periodically and validating test results through use of standardized
				  control specimens or laboratories.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.14 - Radiology Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Radiology
				  services shall be provided or made available when appropriate to meet the needs
				  of the patients and adequately support the ambulatory surgical center's (ASC's)
				  clinical capabilities. Policy and procedures shall be available for emergency
				  and/or routine radiological procedures.
(b) A radiologist shall authenticate all
				  examination reports, except reports of specific procedures that may be
				  authenticated by physicians who are not radiologists, but who have been granted
				  privileges by the governing body or its designee to authenticate such
				  reports.
(c) Services shall be
				  provided either directly within or through a Medicare-approved facility, and
				  the contracts shall be available for review.
(d) If X-ray services are performed within
				  the ASC, the X-ray department shall be surveyed according to 42 Code of Federal
				  Regulations §482.26 or §§486.100 - 486.110.
(e) Procedure manuals shall include
				  procedures for all examinations performed, infection control in the ASC and
				  operating rooms to include dress code of personnel and cleaning of
				  equipment.
(f) Policies shall
				  address the quality aspects of radiology services, including, but not limited
				  to:
(1) performing radiology services only
				  upon the written order of a physician, dentist, advanced practice registered
				  nurse, or other authorized health care practitioner (such orders shall be
				  accompanied by a concise statement of the reason for the examination);
				  and
(2) limiting the use of any
				  radioactive sources in the ASC to physicians who have been granted privileges
				  for such use on the basis of their training, experience, and current
				  competence.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.15 - Facility Staffing and Training

Current through Reg. 49, No. 28; July 12, 2024
(a) Nursing services.
(1) There shall be an organized nursing
				  service under the direction of a qualified registered nurse (RN). The
				  ambulatory surgical center (ASC) shall be staffed to assure that the nursing
				  needs of all patients are met.
(2)
				  There shall be a written plan of administrative authority for all nursing
				  services with responsibilities and duties of each category of nursing personnel
				  delineated and a written job description for each category. The scope of
				  nursing service shall include, but is not limited to, nursing care rendered to
				  patients preoperatively, intraoperatively, and postoperatively.
(A) The responsible individual for nursing
				  services shall be a qualified registered nurse (RN) whose responsibility and
				  authority for nursing service shall be clearly defined and includes supervision
				  of both personnel performance and patient care.
(B) There shall be a written delineation of
				  functions, qualifications, and patient care responsibilities for all categories
				  of nursing personnel.
(C) Surgical
				  technicians and licensed vocational nurses may be permitted to serve in the
				  scrub nurse role under the direct supervision of an RN; they shall not be
				  permitted to function as circulating nurses in the operating rooms. Licensed
				  vocational nurses and surgical technicians may assist in circulatory duties
				  under the direct supervision of a qualified RN.
(D) Nursing services shall be provided in
				  accordance with current recognized standards or recommended
				  practices.
(E) The facility shall
				  adopt, implement and enforce policies and procedures to comply with Health and
				  Safety Code, Chapter 259 (relating to Surgical Technologists at Health Care
				  Facilities).
(3) There
				  shall be an adequate number of RNs on duty to meet the following minimum staff
				  requirements: director of the department (or designee), and supervisory and
				  staff personnel for each service area to assure the immediate availability of
				  an RN for emergency care or for any patient when needed.
(A) An RN shall assign the nursing care of
				  each patient to other nursing personnel in accordance with the patient's needs
				  and the preparation and qualifications of the nursing staff
				  available.
(B) There shall be other
				  nursing personnel in sufficient numbers to provide nursing care not requiring
				  the service of an RN.
(4)
				  An RN qualified, at a minimum, with current certification in basic cardiac life
				  support shall be on duty and on the premises at all times whenever patients are
				  present in the facility.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.16 - Teaching and Publication

Current through Reg. 49, No. 28; July 12, 2024
(a) Policies
				  concerning teaching activities shall be developed, implemented, and enforced
				  which address:
(1) the terms and conditions
				  of reimbursement or other compensation;
(2) the reasonableness of the time spent away
				  from direct patient care and administrative activities; and
(3) the training of all students and
				  postgraduate trainees, including the extent of their involvement in patient
				  care activities.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 135 - AMBULATORY SURGICAL CENTERS › Subchapter A - OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS › Section 135.17 - Research Activities

Current through Reg. 49, No. 28; July 12, 2024
(a) Research
				  activities shall be performed in accordance with ethical and professional
				  practices and legal requirements, and these activities shall be periodically
				  monitored by the governing body.
(b) The protocols for conducting research
				  shall be approved by the governing body or its designee after medical and legal
				  review.
(c) Any research activities
				  carried out within the ambulatory surgical center (ASC) shall be appropriate to
				  the expertise of staff and the resources in the ASC.
(d) Individuals engaged in research shall be
				  provided with adequate facilities.
(e) Provisions shall be made to assure that
				  the rights and welfare of all research subjects are adequately protected and
				  that the informed consent of the subject, in the language spoken by him or her,
				  is obtained by adequate and appropriate methods.
(f) All professional staff shall be informed
				  of the ASC's research policies.