Levels of Maternal and Neonatal Care Designations

PURPOSE: This rule establishes criteria and procedures for reporting standardized assessments and levels of maternal and neonatal care designations for birthing facilities. PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproductions. This note applies only to the reference material. The entire text of the rule is printed here. (1) The following definitions shall apply throughout this rule: (A) “Birthing facility” means any hospital, as defined under section 197.020, RSMo, with more than one (1) licensed obstetric bed or a neonatal intensive care unit, a hospital operated by a state university, or a birthing center licensed under sections 197.200 to 197.240, RSMo; (B) “Department” means the Missouri Department of Health and Senior Services; and (C) “LOCATe” or “CDC Maternal and Neonatal Levels of Care Assessment Tool” refers to a web-based tool created by the Centers for Disease Control and Prevention (CDC) that assists in creating standardized assessments of levels of maternal and neonatal care. LOCATe is based on the most recent guidelines and policy statements issued by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. (2) Each birthing facility shall use the electronic CDC Maternal and Neonatal Levels of Care Assessment Tool (LOCATe) to assess its designation as of December 31 preceding the due date of January 31 every three (3) years. If at any time the birthing facility has any change to its maternal or neonatal care capability that will affect its maternal or neonatal care designation as determined by LOCATe, then the birthing facility shall use LOCATe to reassess its designation within thirty (30) days of the change. If a facility submits an updated survey due to a change in designation, that will not change the schedule of the report required every three (3) years. The electronic LOCATe tool (version 9.2) is incorporated by reference in this rule as published by the Centers for Disease Control and Prevention and available at http://health.mo.gov/locate. This rule does not incorporate any subsequent amendments or additions. (3) The level of care designation for neonatal care selected by the birthing facility within LOCATe shall be based upon the most current standards published by the American Academy of Pediatrics (AAP). The level of care designation for maternal care selected by the birthing facility within LOCATe shall be based upon the most current standards published by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine. (4) Each birthing facility shall have the results of their LOCATe assessment and level of care designations verified by the department, AAP, or the Joint Commission once every three (3) years. When submitting the LOCATe assessment every three (3) years, birthing facilities shall notify the department through the LOCATe survey about how they will have their results verified. The results of the verification shall be submitted electronically to the department through a link provided by the department once the LOCATe assessment has been submitted. (5) Verification processes conducted by AAP or the Joint Commission may include criteria in addition to those included in LOCATe. Verification by the department will only include criteria collected in LOCATe. (6) The department may initiate a review and monitor compliance with the provisions set forth in this rule at any time. The department will provide electronic notification to a birthing facility if it finds that verification does not match the self-designated levels of care. AUTHORITY: section 192.006, RSMo 2016, and section 192.380, RSMo Supp. 2022.* Emergency rule filed Dec. 20, 2018, effective Dec. 30, 2018, expired June 27, 2019. Original rule filed Dec. 20, 2018, effective June 30, 2019. Amended: Filed Sept. 12, 2022, effective March 30, 2023. *Original authority: 192.006, RSMo 1993, amended 1995, and 192.380, RSMo 2017.