NAC442.390. Level II specialty care facilities: General requirements.

     1. A level II specialty care facility must be able to provide:

     (a) The basic care services as described under subsection 1 of NAC 442.380.

     (b) Intermediate care for a minimum of six neonates.

     (c) Stabilization of severely ill neonates before transfer to a level III subspecialty care facility.

     (d) Treatment for moderately ill neonates that were carried to term and larger preterm neonates.

     (e) Collection and retrieval of data as required pursuant to the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370.

     (f) Continuing care of neonates who have a low weight at birth and are not ill but require frequent feeding or require more hours of nursing than normal neonates.

     (g) Intermediate care of sick neonates who do not require intensive care but require 6 to 12 hours of nursing care each day. Neonates who require complex care, such as assisted ventilation for more than several hours, will be moved to a level III subspecialty care facility.

     (h) Cardiopulmonary resuscitative services and continuous monitoring of cardiopulmonary status.

     (i) Care in excess of its designated level for a neonate for not more than 24 hours, while identifying, stabilizing and preparing a high-risk or critically ill neonate for transport to a level III subspecialty care facility.

     (j) Continuing care for convalescing neonates transported from level III subspecialty care facilities.

     (k) Gavage feeding.

     (l) Pharmacy services, including parenteral nutritional solutions, 24 hours per day.

     (m) Laboratory consultation services 24 hours per day.

     (n) Radiological services, such as X-ray, diagnostic imaging procedures and consultation services, 24 hours per day.

     (o) Certified or registered respiratory therapists trained in neonatology on staff 24 hours per day.

     2. A level II specialty care facility must have a medical director who is:

     (a) A neonatologist or a pediatrician who is certified by the American Board of Pediatrics and has special interest, experience or subspecialty certification in neonatal or perinatal medicine;

     (b) Not a medical director of more than two level II specialty care facilities;

     (c) Responsible for the care of neonates in the level II specialty care facility and consults with level I basic care facilities for possible admissions to the level II specialty care facility and with level III subspecialty care facilities for possible transfers from the level II specialty care facility to a level III subspecialty care facility;

     (d) A supervisor of the advanced practice registered nurses in the level II specialty care facility; and

     (e) Able to ensure qualified coverage in his or her absence by other neonatologists or pediatricians with special training and interest in neonatology.

     3. The level II specialty care facility must be staffed in accordance with the current edition of the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370 and must provide nursing staff trained in the care of high-risk neonates. The nursing staff must be supervised by a qualified registered nurse who shall coordinate the care of the neonates in the level II specialty care facility and assist the medical director in the management of the level II specialty care facility.

     4. The level II specialty care facility shall have a written agreement with each level III subspecialty care facility to which it refers neonates. The agreement must include provisions for:

     (a) The education in perinatal care, including neonatal resuscitation, of the staff of the level II specialty care facility;

     (b) Technical assistance in the development of a program of quality assurance for the care provided to neonates by the level II specialty care facility; and

     (c) The return of neonates to the level II specialty care facility for care.

     5. A level II specialty care facility that is unable to secure the agreements required in subsection 4 shall document the efforts it made to secure the agreements and develop a plan to provide level II specialty care services in the absence of such agreements.

     (Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)