Practice Management |

ACOG's Texas Levels of Maternal Care Verification Program: Quality Through Partnership

Texas law now requires all hospitals that provide maternity services to receive a maternal level of care designation by Aug. 31, 2020, to receive Medicaid reimbursement for obstetrical care. Levels II, III, and IV hospitals must have a site survey prior to applying for state designation.


The American College of Obstetricians and Gynecologists (ACOG) launched a new program in Texas to provide survey services for hospitals. Recognizing the critical importance of implementing a program that accounts for the geographic and health care diversity of the lone star state, ACOG involved Texas providers and key organizations in the state in its development; opened a Texas-based office; and recruited more than 130 Texas-based obstetrician-gynecologists, maternal nurses, and maternal-fetal medicine specialists to serve as surveyors.

Collaboration is Key

In addition to the partnership with the Texas Department of State Health Services, ACOG is collaborating with hospitals to improve care and outcomes and address the unique challenges facing Texas health care providers and hospitals. After the site visit, ACOG surveyors will offer an optional confidential consultation that includes highlighting strengths in a hospital’s maternal services and providing recommendations based on ACOG’s clinical guidelines. This program’s primary goal is to support ACOG’s national morbidity and mortality reduction initiatives.

According to Eugene Toy, M.D., medical director for Texas ACOG Levels of Maternal Care Verification Program, collaboration is key. “ACOG recognizes the critical importance of implementing a program that is specific to Texas. We have developed a program that involves key Texas organizations,” said Toy. “We believe that this is a two-way collaboration. No one knows better how to improve maternal outcomes than the people on the ground, doing the work, day in and day out.”

Fighting Maternal Mortality

ACOG is fighting maternal mortality at many levels and has long made levels of maternal care a key organizational priority. In 2015, ACOG and the Society for Maternal-Fetal Medicine (SMFM) released a consensus statement that proposed a national classification system for levels of maternal care.

Subsequently, the Levels of Maternal Care Verification Program was developed through a collaboration led by ACOG and SMFM and included the Centers for Disease Control and Prevention; the National Perinatal Information Center; the Arizona Perinatal Trust; and clinicians representing the American Academy of Family Physicians, the American College of Nurse-Midwives, and the Association of Women’s Health, Obstetric, and Neonatal Nurses.

The team developed a program that involves a comprehensive on-site review to verify the level of maternal care of a hospital in alignment with the ACOG/SMFM guidelines. The team pilot-tested the verification program with hospitals that were geographically and demographically diverse and had different maternal services to ensure this program could be customized by hospitals to meet their unique circumstances.

One hospital administrator stated, “I would like to thank ACOG for the professional, respectful and honest survey that was performed. What could have been a very stressful, tense experience was rather an opportunity to show the care we provide every day and the opportunities for improvement were presented in a nonjudgmental fashion with suggestions for compliance. The debriefing was very well done with both recommendations and opportunities presented in an honest manner.”