Advocacy and Health Policy |

Texas Senate Bill 749 Updates Maternal Designation Requirements

Governor Greg Abbott signed into law SB 749, which enacts changes to the maternal and neonatal designation rules. The Department of State Health Services (DSHS) will provide clarification on these new requirements. At this time, ACOG addresses some of the key changes below.


Please note: This information is provided for educational purposes only. This information should not be considered ACOG guidance and is not meant to be authoritative or imply designation. Texas DSHS makes the determination of designation.

Key Changes

SB749: The maternal designation deadline has been extended by one year to August 31, 2021.

This extension gives hospitals an opportunity to adapt to the new rules, which are forthcoming.

SB749: “…permitting a hospital to satisfy any requirement for a Level I or II level of care designation that relates to an obstetrics or gynecological physician by: (A) granting maternal care privileges to a family physician with obstetrics training or experience; and (B) developing and implementing a plan for responding to obstetrical emergencies that require services or procedures outside the scope of privileges granted to the family physician described by Paragraph (A);”

TX DSHS has not yet issued their interpretation of this change. From a national perspective, ACOG recognizes the acuity and depth of training within the family medicine residency. Therefore, based upon available resources and facility determination of the most appropriate staffing, it may be acceptable for a family physician with obstetric fellowship training or equivalent training and skills in obstetrics, and with surgical skill and privileges to perform cesarean delivery to meet the criteria for being readily available at all times. As with all settings, a plan for handling emergencies, such as cesarean hysterectomy and other operative conditions outside the scope and privileges of family physicians, must be in place.

SB749: Level I, II, and III hospitals may use telemedicine for physician on-call services in accordance with the standard of care applicable to the provision of the same service or procedure in an in-person setting.

Telehealth has quickly become integrated into nearly every aspect of obstetrics and gynecology, and these technology-enhanced health care delivery opportunities serve to enhance current standard of care. There are numerous circumstances where resources are limited, and telemedicine can help with the care in that community. There are a number of considerations in implementing telemedicine programs, and we look forward to receiving guidance from DSHS, as well as serving as a resource for DSHS as they consider implementation of telemedicine in practice and develop the on-call rules. While telemedicine is a wonderful technology, we recognize that there are circumstances that require a physician's presence to the bedside, such as to perform operative procedures, or to review extremely complex clinical data, including an in-person physical examination.

SB749: “…a hospital may obtain a limited follow-up survey by an independent third party to appeal the level of care designation assigned to the hospital;”

ACOG will offer limited follow-up surveys. The cost will be determined based on multiple factors, including the length of the survey, designation level, and complexity. The actual cost for a limited follow-up survey will therefore be individualized accordingly and will be discussed with the hospital upon request.

SB749: “…regardless of a hospital's level of care designation, a health care provider at a designated facility or hospital may provide the full range of health care services: (A) that the provider is authorized to provide under state law; and (B) for which the hospital has granted privileges to the provider;”

ACOG respects that a hospital’s determination of its capabilities and care for patients is separate from designation.

SB749: “The rules adopted under Section 241.183 establishing level of care designations for hospitals must allow a hospital to appeal a level of care designation to a three-person panel…”

ACOG supports efforts to formalize procedures and understands that for a process such as designation, there must be trust in a fair and impartial process. We support DSHS’s implementation of this process.

SB749: Describes the process for a hospital to seek a waiver from Levels of Care designation requirements.

Because maternal levels of care designation is a new process, it is understandable that hospitals are working hard toward understanding the requirements and putting policies, personnel, and structures in place to comply with the rules. We support flexibility in compliance with the rules, since each hospital is unique and there are numerous ways to deliver good care. Nevertheless, to promote the best outcomes for patients, it is imperative that patient care, safety, and quality are not compromised.