NAC442.401. Level III subspecialty care facilities: General requirements.

     1. A level III subspecialty care facility must:

     (a) Be able to care for neonates as provided by NAC 442.390;

     (b) Provide nine or more beds for the intensive care of neonates;

     (c) Provide and adhere to a formal, written plan for in-house coverage of the level III subspecialty care facility by neonatologists, pediatricians, qualified physicians and advanced practice registered nurses, taking into consideration the condition and medical needs of the neonates requiring level III subspecialty care; and

     (d) Have formal, written agreements with each level I basic care facility and level II specialty care facility from which it receives neonates. The agreement must include provisions for:

          (1) Education in perinatal care, including neonatal resuscitation, for the staff of the level I basic care facilities and level II specialty care facilities, on at least an annual basis; and

          (2) Technical assistance in the development of a program of quality assurance for the care provided to neonates by the level I basic care facilities and level II specialty care facilities.

     2. A level III subspecialty care facility that refuses to enter into the required agreements with a level I basic care facility or level II specialty care facility shall show sufficient reason for the refusal and notify the level I basic care facility or level II specialty care facility in writing of the reasons for refusal.

     3. If, after an investigation by the Division into the circumstances of the refusal of the level III subspecialty care facility to enter into an agreement with a level I basic care facility or level II specialty care facility, there is a finding that the level III subspecialty care facility’s reasons for refusal are not sufficient, the Division may order the level III subspecialty care facility to enter into an acceptable agreement and set a time for compliance.

     4. The medical director of a level III subspecialty care facility must:

     (a) Be a neonatologist;

     (b) Devote his or her full time to the direction of the facility;

     (c) Consider transferring a neonate who no longer requires level III subspecialty care to the hospital in which he or she was born; and

     (d) Confer with the attending physician at the hospital in which the neonate was born and the parents or guardians of the neonate before transferring a neonate to the hospital in which he or she was born.

     5. The medical staff of the facility must:

     (a) Include at least one pediatrician or qualified physician with special interest and experience in neonatology for each 10 beds, or fraction thereof, in the facility.

     (b) Be comprised of physicians, not less than one-half of whom are neonatologists or are eligible to take the examination of the American Board of Pediatrics in neonatal-perinatal medicine.

     (c) Include a pediatric cardiologist who is certified by the American Board of Pediatrics, Subboard of Pediatric Cardiology, or a qualified physician whose specialty is pediatric cardiology. If a pediatric cardiologist or qualified physician is not available, a qualified pediatric cardiologist must be actively recruited and the hospital shall enter into agreements with other neonatal facilities to provide pediatric cardiology.

     (d) Include:

          (1) A pediatric surgeon who is certified by the American Board of Surgery, with special qualifications in pediatric surgery; or

          (2) A qualified physician whose specialty is pediatric surgery,

Ê who is available 24 hours per day. If a pediatric surgeon or a qualified physician is not available, a qualified pediatric surgeon must be actively recruited and the hospital shall enter into agreements with other neonatal facilities to provide pediatric surgery.

     6. At least one registered or certified respiratory therapist must be assigned to the facility for every five neonates on an assisted mode of ventilation, including Continuous Positive Airway Pressure.

     7. The nurse manager of the facility must:

     (a) Be a registered nurse;

     (b) Have not less than 3 years of clinical experience in level III subspecialty care; and

     (c) Devote his or her full time to the management of the level III subspecialty care facility.

     8. The nurse manager and medical director of the level III subspecialty care facility shall identify the personnel and determine the educational requirements necessary to meet the needs of:

     (a) The staff of the facility, which must:

          (1) Comply with the current edition of the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370; and

          (2) Include a nursing staff that has experience in the care of high-risk neonates; and

     (b) Any outreach program.

     9. The level III subspecialty care facility shall provide transportation services for critically ill neonates. Personnel used for these services may include physicians, advanced practice registered nurses, registered nurses, respiratory therapists, emergency medical technicians or such other personnel as the medical director deems appropriate.

     10. As used in this section, “qualified physician” means a physician licensed to practice in this State who:

     (a) Has been issued a credential to practice a specialty or a subspecialty in a hospital by the governing board of the hospital; and

     (b) Has, at any time, completed the occupational and educational requirements of a specialty board for the specialty or subspecialty in which he or she is practicing.

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