J Guideline for Application Process for Designation, Redesignation or Change in Designation

Section 640.APPENDIX J   Guideline for Application Process for Designation, Redesignation or Change in Designation Initial Process: The hospital administration shall: Send a Letter of Intent for change in status to the Department and affiliated Administrative Perinatal Center  6 to12 months before expected review by the PAC. Prepare appropriate documents for site visit.  Required documents and assistance with preparation are available through affiliate Administrative Perinatal Center.  The site visit team will include, but not be limited to, Co-Directors of Administrative Perinatal Center and Network Administrator, Perinatal Advisory Committee and Department. The Department will assign the additional representatives required. Send information three weeks in advance of the scheduled site visit to: Illinois Department of Public Health Perinatal Program Administrator 535 West Jefferson Springfield, Illinois 62761 Assemble appropriate representation from the hospital on the day of the site visit to be available to present an overview of the hospital and to answer questions from the site visit team.  Hospital representatives should include at a minimum: •           Hospital administration •           Chair of OB/GYN •           Chair of Family Practice, if appropriate •           Chair of Pediatrics •           Director of Anesthesiology •           Director of Maternal-Fetal Medicine, if appropriate •           Director of Neonatology, if appropriate •           Director of Nursing Once the site visit has been completed and the hospital and Administrative Perinatal Center are satisfied that the application is complete, the Administrative Perinatal Center will contact the Department in writing to schedule application review before the Perinatal Advisory  Committee. On the day of the review, the following representatives must be present from the hospital to be reviewed: •           Hospital administration •           Chair of OB/GYN •           Chair of Family Practice, if appropriate •           Chair of Pediatrics •           Director of Maternal-Fetal Medicine, if appropriate •           Director of Neonatology, if appropriate •           Director of Nursing •           Co-Directors of Affiliate Perinatal Network •           Network Administrator from Affiliate Perinatal Network •           Other personnel as identified by hospital, Perinatal Advisory Committee or Sub-Committee After reviewing the application, the PAC will present a formal outline of the issues and recommendations to the Department. After review of the recommendations and deliberations, the Department will send a formal letter as to the status of the hospital. The hospital and the Administrative Perinatal Center will work together to address the recommendation in the follow-up letter. The Administrative Perinatal Center will be responsible for monitoring any indicators or required changes that are identified by the PAC. In preparation for re-review, the hospital and Administrative Perinatal Center will prepare information only on issues addressed in the follow-up letter. The Administrative Perinatal Center will contact the Department to schedule the re-review meeting. The Administrative Perinatal Center will send appropriate documents, identified in the follow-up letter, to the Department three weeks before the re-review is scheduled. Only representatives from the Administrative Perinatal Center shall attend the re-review meeting to answer any questions the review committee may have concerning the identified items.  Hospital representatives may attend the meeting if they choose. The Illinois Department of Public Health will send a formal follow-up letter to the hospital and the Administrative Perinatal Center concerning the outcome of the meeting and any follow-up instructions.