Note: This page is exerped from current
legislative language pertaining to services that can be legally
provided in Level I, Level II, and Level III neonatal units. ACHA
is in the process of revising these regulations, and has asked
the Florida Society of Neonatologists for input. Please comment
in the discussion group section.
Neonatal Care Services: The aspect of
perinatal medicine pertaining to the care of neonates. Hospital
units providing neonatal care are classified by the intensity and
specialization of the care which can be provided. The agency
distinguishes 3 levels of neonatal care services:
- Level 1 Neonatal Services. Well-baby
care services, which include sub-ventilation care,
intravenous feedings, and gavage to neonates are defined
as level 1 neonatal services. Level 1 neonatal services
do not include ventilator assistance except for
resuscitation and stabilization. Upon beginning
ventilation, the hospital shall implement a patient
treatment plan which shall include the transfer of the
neonate to a Level II or a Level III intensive care
service at such time as it becomes apparent that
ventilation assistance will be required beyond the
neonates resuscitation and stabilization. The Hospital
shall establish a triage procedure for to assess the need
for transfer of obstetrical patients to facilities with
level II or Level III neonatal intensive care services
prior to their delivery where there is an obstetrical
indication that resuscitation will be required for their
neonates. Facilities with Level I neonatal services may
only perform Level I neonatal services.
- Level II Neonatal Intensive Care Services. Services
which include the provision of ventilator assistance, and
at least 6 hours of nursing care per day shall be defined
as Level II neonatal intensive care services. Level II
services shall be restricted to neonates with 1000 grams
birth weight and over with the following exception.
Ventilation may be provided in a facility with Level II
neonatal intensive care services for neonates of less
than 1000 grams birth weight only while waiting to
transport the baby to a facility with Level III neonatal
intensive care services. All neonates of 1000 grams birth
weight or less shall be transferred to a facility with
Level III neonatal intensive care services. Neonates
weighing more than 1000 grams requiring one of more of
the level III services, as defined in this rule, shall
also be transferred to a facility with Level III neonatal
intensive care services. If a facility with level III
neonatal intensive care services refuses to accept the
transfer patient, the facility with level II neonatal
intensive care services will be found in compliance with
this sub-paragraph upon a showing of continuous good
faith effort to transfer the patient as documented in the
patient's medical record. Facilities with level II
neonatal intensive care services may perform only level 1
neonatal intensive care services, and level II neonatal
intensive care services as defined in this rule.
- Level III Neonatal Intensive Care Services. Services
which include the provision of continuous cardiopulmonary
support services, 12 or more hours of nursing care per
day, complex neonatal surgery*, neonatal cardiovascular
surgery, pediatric neurology and neurosurgery, and
pediatric cardiac catheterization shall be classified as
level III neonatal intensive care services. These
services cannot be performed in a facility with level II
neonatal intensive care services only. Facilities with
level III neonatal intensive care may perform all
neonatal care services. A facility with level III
neonatal intensive care services that does not provide
treatment of complex major congenital anomalies that
require the services of a pediatric surgeon, or a
pediatric cardiac catheterization and cardiovascular
surgery shall enter into a written agreement with a
facility providing Level III neonatal intensive care
services in the same or nearest service area for the
provision of these services. All other services shall be
provided at each facility with level III neonatal
intensive care services. The provision of pediatric
cardiac catheterization and pediatric open heart surgery
each require a separate certificate of need.
* Complex Neonatal Surgery is defined in another section
of the rule as: Any surgical procedure performed upon a
neonate by a surgically credentialed practitioner licensed
under the provisions of chapter 458 or 459, F.S., which is
associated with entry into or traversing a body cavity, such
as the abdomen, thorax or cranium, with a requirement for
either general anesthesia or conscious sedation. Such
procedures shall be performed only in hospitals licensed
under the provisions of chapter 395, F.S., which are also
authorized to provide level III neonatal intensive care
services under the provisions of Chapter 59A-3.1200 to 3.231,
F.A.C.
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