Texas Hospital Level of Care Designation for Maternal Care: Blood Bank Effects

by Laurie J. Sutor, MD, MBA

Area hospitals and the community blood center have become aware of new sections of the Texas Administrative Code and the Health and Safety Code that, in their standard-setting for maternal care for the state, are having significant effects on blood banks. The legislation was first passed in 2013 and modified slightly in 2015. It took effect in March of 2018 with a window period for facilities to become compliant.

A nineteen-member perinatal advisory council set the requirements for four levels of care for hospitals seeking maternal designation for Medicaid reimbursement. Level I is the most basic and Level IV is the most advanced. Level I (“Basic Care”), which assumes care of essentially healthy obstetric patients with no underlying illnesses or risk of morbidity or mortality, will still require 24-hour blood bank coverage and massive transfusion capability. Levels II to IV, which cover increasing complexity of care and risk to the obstetric patient, require (in addition to the above) the following to be available on site at all times:

• ABO and Rh specific or Group O, Rh negative red cells
• Cryoprecipitate
• Frozen plasma
• Apheresis platelets

The effect of these new designations has become apparent in recent months. Many hospitals, who never stocked cryoprecipitate or apheresis platelets previously, have been requesting them from the blood center in the process of applying for their new level of care designation. It is anticipated this change will put a strain on the apheresis platelet community inventory by requiring more units to be out at hospitals, even though many of these units will probably never be needed for transfusion.

Reference:
1. Subchapter H of the Health and Safety Code, Sections 241.182 (Level of Care Designations) through 241.187(Perinatal Advisory Council)
2. Texas Administrative Code, Title 25, Part 1, Chapter 133, Subchapters C and K