TITLE 7 HEALTH
CHAPTER 10 FREESTANDING BIRTH CENTERS
PART 2 REQUIREMENTS
FOR FREESTANDING BIRTH CENTERS
7.10.2.1 ISSUING
AGENCY: New Mexico Department of Health, Division of
Health Improvement.
[7.10.2.1
NMAC - N, 3/1/2016]
7.10.2.2 SCOPE:
A. These regulations
apply to public, for profit and non-profit freestanding birth centers providing
the services specified in these regulations.
Any freestanding birth center providing services specified in these
regulations must be licensed under these regulations prior to obtaining federal
certification.
B. These regulations
do not apply to:
(1) hospitals
that provide labor and delivery services under their hospital license;
(2) births
performed in a private residence by licensed midwives or certified nurse midwives
acting within the scope of their license; and
(3) offices
and treatment rooms of a licensed private practitioners.
[7.10.2.2
NMAC - N, 3/1/2016]
7.10.2.3 STATUTORY AUTHORITY: The regulations set forth herein are
promulgated by the secretary of the New Mexico department of health, pursuant
to the general authority granted under Subsection E of Section 9-7-6 NMSA 1978 of
the Department of Health Act, as amended; and the authority granted under
Subsection D of Section 24-1-2, Subsection I of Section 24-1-3, Subsection R of
Section 24-1-3 and 24-1-5 NMSA 1978 of the Public Health Act, as amended.
[7.10.2.3
NMAC - N, 3/1/2016]
7.10.2.4 DURATION: Permanent.
[7.10.2.4
NMAC - N, 3/1/2016]
7.10.2.5 EFFECTIVE
DATE: March 1, 2016, unless a later date is cited
at the end of a section.
[7.10.2.5
NMAC - N, 3/1/2016]
7.10.2.6 OBJECTIVE:
A. To encourage the establishment and
maintenance of freestanding birth centers which provide quality care within a
safe home like environment for mothers and infants.
B. To establish
minimum standards for licensing of freestanding birth centers that provide birthing
services different from, and outside the acute care hospital setting, while
promoting safety and quality care for mothers and infants.
C. To monitor freestanding
birth center compliance under these regulations through surveys and to identify
any facility areas in which could be dangerous or harmful.
[7.10.2.6
NMAC - N, 3/1/2016]
7.10.2.7 DEFINITIONS:
A. “AABC” means American association of birth
centers.
B. “Administrator” means the person who is
delegated the administrative responsibility for interpreting, implementing, and
applying policies and procedures at the birth center. The administrator is responsible for establishing
and maintaining safe and effective management, control and operation of the facility
and all of the services provided at the facility, including fiscal management. The administrator must meet the minimum
administrator qualifications in these regulations.
C. “Applicant” means the individual or
legal entity that applies for a license.
If the applicant is a legal entity, then the individual signing the
license application on behalf of the legal entity must have written legal
authority from the legal entity to act on its behalf and execute the
application. The license applicant must
be the legal owner of the facility.
D. “Apprentice midwife” means an individual
as defined in and licensed under 16.11.3 NMAC, as amended, and currently in
good standing.
E. “ACNM” means the American college of nurse
midwives.
F. “Basic life support” (BLS) means training
and current certification in adult cardiopulmonary resuscitation equivalent to
American heart association class C basic life support and in emergency treatment of a victim of cardiac or respiratory
arrest through cardiopulmonary resuscitation and emergency cardiac care.
G. “Birth assistant” means a staff person
over the age of 18 who is capable of recognizing complications and who can care
for the mother and infant by performing normal postpartum and newborn care. At a minimum, a birth assistant must be trained
and have current certifications in BLS and neonatal resuscitation program (NRP)
and can only function under the direct supervision of a licensed provider
immediately available on site.
H. “Birth center” (BC) means a freestanding
birth center licensed by the state for the primary purpose of performing
low-risk deliveries that is not a hospital, attached to a hospital or in a
hospital, and where births are planned to occur away from the mother’s
residence following a low-risk pregnancy.
I. “Birth room” or “birthing room” means a private room
of sufficient size to accommodate a client in active labor with the equipment
and personnel necessary to assist the mother in a safe birth and in full
compliance with the minimum standards in these regulations. Any facility with four or more birthing rooms
must also comply with the birthing room and center requirements in the current
edition of the facility guidelines institute, guidelines for design and construction,
specific requirements for freestanding birth centers.
J. “CABC” means the commission for the accreditation
of birth centers.
K. “Certified nurse midwife” means a licensed
individual educated in the two disciplines of nursing and midwifery as defined
and licensed under 16.11.2 NMAC, as amended, and currently in good standing.
L. “Certified nurse practitioner” means a
registered nurse as defined and licensed under the Nursing Practice Act, Section
61-3-23.2 NMSA 1978, as
amended, and related regulations and is currently in good standing.
M. “CLIA” means Clinical Laboratory
Improvement Amendments of 1988 as amended.
N. “Client” means any person who receives
care, including a mother, infant or newborn, at a freestanding birth center.
O. “Compliance” means the facility’s adherence to these regulations, as well as any and all other applicable state and
federal statutes and regulations. Compliance
violations may result in sanctions, civil monetary penalties and revocation or
suspension of the facility license.
P. “Deficiency” means a violation of or
failure to comply with any provision(s) of these regulations.
Q. “Department” means the New Mexico
department of health.
R. “Employee” means any person who works at
the facility and is a direct hire of the owner or management company, if
applicable.
S. “External quality
committee” means the members of the internal quality committee and an
external peer reviewer or a clinical consultant and any other facility
healthcare partners, as available.
T. “Facility” means the physical premises,
building(s) and equipment where the freestanding birth center services are
provided, whether owned or leased and which is licensed pursuant to these
regulations.
U. “Incident” means any known, alleged or suspected event of abuse,
neglect, exploitation, injuries of unknown origin or other reportable
incidents.
V. “Incident management system” means the written policies and procedures
adopted or developed by the licensed health facility for reporting abuse,
neglect, exploitation, injuries of unknown origin or other reportable
incidents.
W. “Incident report form” means the reporting format issued by the
department for the reporting of incidents or complaints.
X. “Internal quality committee” means and
includes the administrator and clinical director at a minimum. If the administrator and clinical director
are the same person, another staff person with clinical experience must serve
on the internal quality committee. Other
staff at the facility may also serve on this committee as deemed appropriate.
Y. “License” means the document issued by
the licensing authority pursuant to these regulations granting the legal right
to operate a birth center for a specified period of time, at the physical
premises, not to exceed one year.
Z. “Licensee” means the person(s) or legal
entity that operates the physical premises and facility and in whose name the
facility license has been issued and who is legally responsible for compliance
with these regulations.
AA. “Licensed midwife” means a licensed individual
as defined and licensed under 16.11.3 NMAC, as amended, currently in good
standing.
BB. “Licensed practical nurse” means a licensed
individual as defined and licensed under the Nursing Practice Act, Section
61-3-19 NMSA 1978, as amended, currently in good standing.
CC. “Licensing authority” means the New
Mexico department of health.
DD. “Low risk pregnancy” means a pregnancy
that is determined by documented medical history, risk assessment, and prenatal
care that reasonably predicts an outcome of a normal and uncomplicated labor
and birth.
EE. “Management company” means the legal
entity that manages the facility, if different from the legal owner of the
facility.
FF. “Midwife” means a licensed individual
authorized to practice midwifery in New Mexico as defined and licensed under
16.11.2 NMAC, as amended, or 16.11.3 NMAC, as amended, currently in good
standing.
GG. “NFPA” means the national fire protection
association which sets codes and standards for building fire safety.
HH. “NMSA” means the New Mexico Statutes
Annotated 1978 compilation and all subsequent amendments, revisions and
compilations.
II. “Neonatal
resuscitation program” (NRP)
means training and current certification in both the NRP module on medications
and the module on intubation using an endotracheal tube (ET) or laryngeal
mask airway (LMA) or both, endorsed by American academy
of pediatrics or the American heart association.
JJ. “Quality assurance” means the licensed health care facility’s
on-going comprehensive self-assessment of compliance with these regulations and
any and all other applicable statutes and regulations including, but not
limited to,, the facility’s own policies and procedures and incident
investigations, documentation, reporting and reviewing of all alleged incidents
of abuse, neglect, exploitation, injuries of unknown origin or other reportable
incidents for study and improvement of the facility’s organizational,
administrative and preventative practices in employee training and reporting.
KK. “Quality improvement system” means a systematic approach to the
continuous study and improvement of the efficacy of organizational,
administrative and clinical practices to meet the needs of persons served,
address any changing regulatory requirements and achieve the facility’s mission,
values and goals.
LL. “Physician” means a licensed individual,
currently in good standing, authorized to practice medicine as defined and
licensed under the New Mexico Medical Practice Act, Sections 61-6-1 to 61-6-34
NMSA 1978, as amended, and related regulations or osteopathic medicine as
defined and licensed under Sections 61-10-1 to 61-10-22 NMSA 1978, as amended,
and related regulations.
MM. “Physician's assistant” means an individual, currently in good
standing, who is licensed and authorized to
provide services to patients under the supervision and direction of a licensed
physician under the Physician Assistant Act, Sections 61-6-7 to 61-6-10 NMSA
1978, as amended and related regulations, or is authorized and licensed to
provide services to patients under the supervision and direction of a licensed
osteopathic physician under the Osteopathic Physicians' Assistants Act,
Sections 61-10A-1 to 61-10-7 NMSA 1978 as amended, and related regulations.
NN. “Plan
of correction” (POC) means the
plan submitted by the licensee or its representative(s) addressing how and when
deficiencies identified through a survey or investigation will be corrected. A plan of correction is a public record once
it has been approved by the regulatory authority and is admissible for all
purposes in any adjudicatory hearing and all subsequent appeals relating to a
facility license, including to prove licensee compliance violations or failures.
OO. “Policy” means a written statement that
guides and determines present and future facility decisions and actions.
PP. “Premises” means all of the facility
including buildings, grounds and equipment.
QQ. “Procedure” means the action(s) that
must be taken in order to implement a written policy.
RR. “Registered nurse” means an individual,
currently in good standing, who is licensed and authorized to provide nursing
services under the Nursing Practice Act, Sections 61-3-1 to 61-3-30 NMSA 1978,
as amended, and related regulations.
SS. “Scope of practice” means the
procedures, actions, and processes that a healthcare practitioner is permitted
to undertake under the terms of their professional license. The scope of practice is limited to that which
the applicable law allows for specific education, training, experience and demonstrated
competency.
TT. “Staff” means any person who works at
the facility, and includes employees, contracted persons, independent
contractors and volunteers who perform work or provide goods and services at
the facility.
UU. “U/L approved” means approved for
safety by the national underwriters laboratory.
VV. “Variance” means a written decision,
made at the licensing authority’s sole discretion, allowing a licensee and
facility to deviate from a portion(s) or provision of these regulations for a
specified time period not exceeding a year, providing the variance does not jeopardize
the health, safety or welfare of the facility’s clients, patients and staff and
is not in violation of other applicable state and federal statutes and
regulations.
WW. “Violation” means any and all actions or procedures by the facility
or licensee that are not in compliance with these regulations and any and all
other applicable state and federal statutes and regulations.
XX. “Waive” or “waiver” means a written
decision, made at the licensing authority’s sole discretion, to allow a birth center
to refrain from complying with a portion(s) or provision of these regulations
for a limited and specified time period not exceeding a year, providing the
waiver does not jeopardize the health, safety or welfare of the facility’s
clients, patients and staff and is not in violation of other applicable state
and federal statutes and regulations.
[7.10.2.7
NMAC - N, 3/1/2016]
7.10.2.8 STANDARD
OF COMPLIANCE: The degree
of compliance required throughout these regulations is designated by the use of
the words “shall” or “must” or “may”. “Shall”
or “must” means mandatory compliance. “May”
means permissive compliance. The words “adequate”,
“proper”, and other similar words mean the degree of compliance that is
generally accepted throughout the professional field by those who provide
birthing services to the public in facilities governed by these regulations. However, if any other applicable statute or
regulation requires mandatory or stricter compliance for birth center services
than these regulations, the licensee and facility must comply with the more strict
compliance requirements.
[7.10.2.8
NMAC - N, 3/1/2016]
7.10.2.9 FREESTANDING
BIRTH CENTER SCOPE OF SERVICES:
A. General scope of services. Freestanding birth centers endorse the wellness care model by providing supportive care and using
interventions only when medically necessary. Birth centers may provide women’s
health services including annual exams, contraception counseling,
pre-conception counseling, sexually transmitted infection testing and treatment,
prenatal care, birth services, and postpartum and newborn care following a
normal, low risk pregnancy. The facility
may offer other health services by licensed professionals working within the scope
of their license providing the physical space used by the other services is clearly
delineated and separate from the birth center services, the other services do
not interfere with any birth center requirements, the facility complies with
any applicable licensing regulations for the other services, and the department
is capable of determining the physical boundaries between the birth center facilities
licensed under these regulations and other facilities, if licensed under other
regulations.
B. Limitations on scope of services. Except in the event of an emergency, surgical
procedures shall be limited to those normally performed during birth, but may
include episiotomy and repair, other procedures for newborns, and well women’s
care but only if such procedures are performed by a licensed practitioner
acting within the scope of the practitioner’s license. Trials of labor after cesarean section
(TOLAC) and vaginal birth after cesarean (VBAC) services shall only be
performed at a freestanding birth center by a practitioner whose license
authorizes this scope of practice.
C. Services not allowed
and not to be performed at freestanding birth center. The following services shall not be performed
in a freestanding birth center:
(1) general,
regional or epidural anesthesia services;
(2) medications
for cervical ripening, induction or augmentation of labor;
(3) operative
vaginal forceps or vacuum or abdominal births; and
(4) abortions.
D. Geographic requirements.
(1) Freestanding birth centers shall be
located within a maximum of 30 minutes normal driving time from a referral
hospital. Reliable evidence of normal driving
time must be provided.
(2) The
department may, at its sole discretion, approve a variance for a freestanding
birth center that is located more than 30 minutes normal driving time from a
referring hospital, if the department finds that the health and safety of the
birth center clients will not be adversely affected.
E. Additional
requirements applicable to facilities with four or more birthing rooms. Any and all facilities with four or more
birthing rooms shall comply with all of these regulations and also with all
applicable requirements in the current edition of the facility guidelines institute’s
guidelines for design and construction, specific requirements for freestanding birth
centers.
[7.10.2.9
NMAC - N, 3/1/2016]
7.10.2.10 LicensE
REQUIRED: A
freestanding birth center facility shall not be operated without a license
issued by the department. Any
freestanding birth center or facility operating after the effective date of
these regulations, must be licensed under these regulations. Any facility providing the services described
in these regulations after the effective date of these regulations, shall apply
for a freestanding birth center license within 180 days. Any unlicensed freestanding birth center that
has not applied for a license, may only continue to operate without a license
for 180 days from the effective date of these regulations. A freestanding birth center licensed under
these regulations shall not assert, represent, offer, provide or imply that the
facility is or may render care or services other than the services it is
permitted to render under these regulations and within the scope of all
applicable professional license(s). If an
unlicensed freestanding birth center is found to be providing services for
which a license is required under these regulations, the secretary may issue a
cease-and-desist order, to protect human health or safety or welfare. The licensed facility may request a hearing
that shall be held in the manner provided under these regulations and all other
applicable regulations.
[7.10.2.10
NMAC - N, 3/1/2016]
7.10.2.11 INITIAL LICENSURE PROCEDURES: These regulations should be thoroughly
understood and used by the applicant, when applying for the initial freestanding
birth center license. The applicant for
an initial facility license under these regulations must follow these
procedures when applying for a license.
A. Notification and letter
of intent: The owner shall advise
the licensing authority of its intent to open a freestanding birth center
pursuant to these regulations by submitting a letter of intent. The letter of intent must be on the applicant's
letterhead and signed by a person with authority to make legal decisions for
the owner and the facility and at a minimum, include the following:
(1) the
name of facility;
(2) the
name of the legal owner and licensee and the type of legal entity under which
the facility shall be owned;
(3) the
name of the management company, if any;
(4) the
type of facility license requested;
(5) the
anticipated number of clients to be served;
(6) the
number of birthing rooms in the proposed facility;
(7) the physical address of facility
including building name or suite number;
(8) the
mailing address, if different from physical address;
(9) the
contact name(s), address, e-mail address, and telephone number(s);
(10) the
anticipated payers and sources of reimbursement; and
(11) a
list of all services, medical and non-medical, to be provided at the facility
location which is requesting the license.
B. License application and fees: After review by the department of the
letter of intent for general compliance with these regulations and verification
that an application is appropriate under these regulations, the owner shall be
required to complete a license application on a form provided by the
department. Prior to any construction,
renovation or addition to an existing building and after review and approval of
the letter of intent by the department, the applicant must submit to the licensing
authority an application form provided by the department, fully completed,
printed or typed, dated, signed, and notarized accompanied by the required fee. If electronic filing of license applications
is available at the time of application, the applicant will be required to
follow all electronic filing requirements, and may forgo any notary
requirements, if specifically allowed under the applicable electronic filing
statutes, regulations and requirements. Current
fee schedules will be provided by the licensing authority. The department reserves the right to require
additional documentation to verify the identity of the applicant in order to
verify whether any federal or state exclusions may apply to the applicant. Fees must be paid in the form of a certified
check, money order, personal, or business check, or electronic transfer (if
available), made payable to the state of New Mexico, and are non-refundable.
C. Existing facility
and building plans: As part of the initial
license application, the applicant must also attach to the application and submit
to the department, a set of building plans which includes all of the information
required by these rules, accompanied by proof of zoning approvals by the
applicable building authority. The existing
facility building plans must be of professional quality, on substantial paper
measuring at least 24” x 36”, and drawn to an accurate scale of one-eighth inch
to one foot. The plans for existing
construction must include sufficient information for the department to make a
compliance determination and at a minimum:
(1) floor
plans showing proposed use of each room, (e.g., waiting room, examination room,
office, etc.);
(2) interior
dimensions of all rooms;
(3) one
building or wall section showing an exterior and interior wall construction section
including the material composition of the floor, wall, and ceiling/roof, and
the finishes, (e.g., carpet, tile, gypsum board with paint, or wood paneling);
(4) door
locations and types (swing) and sizes of all doors, including width, height and
thickness;
(5) location
of all sinks, tubs and showers;
(6) location
and operation of windows including size and type;
(7) location
and dimension of all level changes within and outside the building, (e.g.,
steps or ramps);
(8) location
of fire extinguishers, heat and smoke detectors, and operational elements of alarm
systems;
(9) location
of heating units, furnaces, hot water heaters, and fuel type and source;
(10) all heating, ventilating and air
conditioning/cooling systems;
(11) location of the building on a site/plot
plan to determine surrounding conditions, include all steps, ramps, parking
areas, handicapped spaces, walks and any permanent structures, including construction
materials; and
(12) all
existing construction, new construction, remodeled portions, and proposed additions,
must be delineated on the plans, clearly indicating where existing construction
ends and proposed remodeling and new construction begins.
D. Remodeling, new and proposed construction: If the proposed facility includes any
remodeling, renovations or additions to an existing building or new
construction of any type, building plans and specifications covering all
portions of the proposed work delineating all existing construction and all new
and proposed construction shall be attached to the application and submitted to
the department for review and approval as part of the application. Building plans will be reviewed by the
department for compliance with current licensing regulations, building and fire
safety codes. If the facility’s building
plans are approved by the department and local building officials have issued a
construction permit, construction may begin.
This provision is an ongoing requirement and applies to, and includes any
and all construction at the facility, which occurs before and after issuance of
the initial license. This provision does
not generally apply to maintenance and repair.
However, if the maintenance or repair impacts or alters any of the
facility requirements under these regulations, the applicant or licensee must
notify the department and verify ongoing compliance with these
regulations. The department shall not be
liable for any costs or damages incurred by the applicant relating to
construction in the event the applicant incurs costs or damages in order to
comply with these regulations or to obtain a license under these
regulations. For all new and proposed construction,
the applicant or licensee must submit for approval by the department before
construction begins, the following:
(1) one
copy of building plans and specifications, including a site plan, that are of
professional quality, on substantial paper measuring at least 24” x 36” and
drawn to an accurate scale of one-eighth inch to one foot;
(2) the
building plans must be drawn to scale and show the general arrangement of the buildings,
and include a room schedule, show fixed equipment for each room, and list room
numbers, together with all other pertinent explanatory information addressing
the requirements in applicable regulations;
(3) any changes in the approved building plans affecting
compliance with these rules shall be shown on the approved plans and shall be
submitted to the department for approval before construction is undertaken;
(4) any
and all completed new construction shall comply with the plans and
specifications approved by the department prior to construction, these rules,
and any and all other applicable rules and codes; and
(5) any of the department’s
approval(s) shall not waive any other rules or other applicable building and
code requirements enforceable by other authorities.
E. Initial survey phase: Upon receipt of a properly completed
application with all necessary supporting documentation, an initial life safety
survey of the proposed facility will be scheduled by the licensing authority. Upon completion of the initial life safety survey
and determination that the facility is in compliance with all life safety and building
requirements, the licensing authority may issue a temporary license pending
completion of its initial health survey or an annual license if allowed or
applicable under these regulations.
[7.10.2.11
NMAC - N, 3/1/2016]
7.10.2.12 ADDITIONAL DOCUMENTS REQUIRED
WITH LICENSE APPLICATION:
The department reserves the right to require an applicant to provide any
and all additional documents, as part of its license application, in order for
the department to determine whether the applicant and the facility are in full
compliance with these regulations, as well as any and all other applicable
statutes and regulations. At a minimum,
additional documents required to be attached to the initial license
application, include, but are not limited to:
A. Building approvals: The applicant must submit all building
approvals required for the facility to operate in the jurisdiction in which it
is located, including, but not limited to,,:
(1) written
building approvals and certificates of occupancy from the appropriate authority
(state, city, county, or municipality) for business occupancy; and
(2) written
fire safety approvals from the fire safety authority having jurisdiction.
B. Environment approvals: If applicable or required, the applicant must
provide written approval from the New Mexico environment department for the
following:
(1) private water supply;
(2) private
waste or sewage disposal; and
(3) ultrasound
equipment.
C. Board of pharmacy
approvals: A copy of facility’s drug
permit issued by the state board of pharmacy must be provided.
D. Program outline: The applicant must submit with its license
application a program outline consistent with these regulations which includes
at a minimum, the following information:
(1) a
list of all services and the scope of those services to be provided by the
proposed facility;
(2) projected
number of clients to be served monthly;
(3) a
list of staffing and personnel
requirements and duties to be performed;
(4) a
list of all services that will be contracted or arranged with any other health
providers including ambulance services, admitting hospitals, consultation with
medical practitioners, laboratory work and equipment providers;
(5) the
number of examination rooms, birth rooms, family rooms and other rooms for
diagnostic or other use including, but not limited to,, ultrasound, laboratory,
clean linen storage and waste disposal;
(6) an
organizational structure diagram or chart including the administrator, advisory
body or board of directors, if any, staff, clinical director, internal quality
committee and external quality committee; and
(7) quality
improvement systems and quality assurance processes.
E. Policies and procedures: The applicant
must submit with its license application a copy of the facility’s policies and
procedures which must comply with these regulations.
[7.10.2.12
NMAC - N, 3/1/2016]
7.10.2.13 LICENSE TYPES, VARIANCES &
WAIVERS:
A. Temporary license: The licensing authority may, at its sole
discretion, issue a temporary license to a new freestanding birth center before
clients are admitted or for facilities that existed prior to enactment of these
regulations, provided that the freestanding birth center has submitted a
license application, supporting documents, has met all of the applicable life
safety code requirements, and its program, policies, and procedures have been
reviewed for compliance with these regulations.
A temporary license is not guaranteed under these regulations and shall
be limited and restricted to:
(1) a
period of time, not to exceed 120 days, during which the facility must correct
all specified deficiencies;
(2) no
more than two consecutive temporary licenses shall be issued in accordance with
applicable statutes and regulations;
(3) the
facility being allowed to accept clients and provide care services, subject to
any requirements and restrictions attached to the temporary license;
(4) a
finding that the applicant is qualified and in full compliance with applicable
life safety code requirements; and
(5) any
determination of compliance or noncompliance for a temporary license or initial
license shall be made at the licensing authority’s sole discretion based upon
the health, safety, or welfare of the facility’s clients, patients and staff
and proof by the applicant that it is not in violation of other applicable
state and federal statutes and regulations.
B. Annual license: An annual license is issued for a one-year
period to a freestanding birth center facility which has met all requirements
of these regulations. If a temporary
license is issued, once the department has issued a written determination of
full compliance with these regulations, an annual license will be issued with
the renewal date of the annual license based upon the initial date of the first
temporary license.
C. Amended license:
A licensee must apply to the licensing authority
for an amended license when there is a change of administrator or when there is
a change of name for the facility, but an amended license shall only be issued if
the administrator is not an owner. If
the administrator is also the owner, a new license application must be
submitted as provided in this regulation.
The amended license application must:
(1) be
on a form, or filed electronically if available, as required by the licensing
authority;
(2) be
accompanied by the required fee for the amended license; and
(3) be
submitted within 10 working days of the change.
D. Variances and waivers: At the licensing authority’s sole discretion,
an applicant or licensee may be granted variances and waivers of these
regulations, provided the granting of such variance or waiver shall not
jeopardize the health, safety or welfare of the facility’s clients, patients
and staff and is not in violation of other applicable state and federal
statutes and regulations. All variances
and waivers shall be in writing attached to the license and shall be limited to
the term of the license. Upon renewal of
a license, any variances and waivers shall only be extended or continued at the
sole discretion of the licensing authority providing such variance or waiver
shall not jeopardize the health, safety or welfare of the facility’s clients,
patients and staff and is not in violation of other applicable state and
federal statutes and regulations at the time of renewal. Variances and waivers are non-transferrable and
shall not be granted indefinitely.
[7.10.2.13
NMAC - N, 3/1/2016]
7.10.2.14 LICENSE RENEWAL:
A. Licensee must
submit a renewal application, electronically, if available, or on forms authorized
by the licensing authority, along with the required license fee at least 30
days prior to expiration of the current license. The applicant shall certify that the facility
complies with all applicable state and federal regulations in force at the time
of renewal and that there has been no new construction or remodeling or
additions which differ from the plans provided and reviewed with the prior license
application. If there has been any
construction or remodeling or additions to the facility since issuance of the
last license, and the construction has not been previously approved, the license
renewal applicant shall be required to comply with all construction
documentation requirements under these regulations when applying for the
license renewal. The department reserves
the right to require that a renewal applicant provide any and all additional
documents, including any necessary proof of current compliance, as part of its
license renewal application in order for the department to determine whether
the applicant and the facility are in full compliance with these regulations.
B. Upon receipt of the
renewal application and the required fee, the licensing authority will issue a
new license effective the day following the date of expiration of the current
license, if the facility is in substantial compliance with these regulations
and any and all other applicable state and federal regulations.
C. If the existing
license expires and the licensee has failed to submit a renewal application, the
department may charge the applicant a late fee of $100 for each month or
portion of a month that the facility continues to operate without a license
providing that during such time the facility remains in full compliance with
these regulations. If the facility does
not renew its license and continues to operate without paying late fees and
without being in full compliance with these regulations, the facility shall
cease operations until it obtains a new license through the initial licensure
procedures, and shall still be required to pay late fees. Under Section 24-1-5 NMSA 1978, as amended, no
freestanding birth center shall be operated without a license and any such
failure may subject the operators to various sanctions and legal remedies,
including at a minimum the imposition of civil monetary penalties.
D. It shall be the
sole responsibility and liability of the licensee to be aware of the status,
term and renewal date of its license. The
licensing authority shall not be responsible to notify the facility of the
renewal date or the expiration date of the facility’s license.
E. After issuance of the initial
license, if there has been no construction or remodeling or additions to the
facility and the facility is in substantially the same condition as the plans
on file with the department, the facility may be issued a license renewal based
upon its accreditation status if it has been fully accredited by an approved
national accrediting organization such as, the commission for the accreditation
of birth centers or its successor, and the facility maintains its accreditation
status throughout the course of the license term. The licensee shall be responsible for
providing verifiable evidence of accreditation status with its license renewal
application and any time during the term of its license upon request. The department, at its sole discretion,
reserves the right to require additional documentation of compliance with these
regulations and all applicable state and federal statutes and regulations by
the licensee at the time of license renewal, even if the facility is accredited
by an approved national accrediting organization.
[7.10.2.14
NMAC - N, 3/1/2016]
7.10.2.15 POSTING OF LICENSE: The facility's license must be posted in a
conspicuous place on the licensed premises in an area visible to the public.
[7.10.2.15
NMAC - N, 3/1/2016]
7.10.2.16 NON-TRANSFERABLE RESTRICTION ON
LICENSE:
A. A license granted
under these regulations is not transferable to any other owner, whether an
individual or legal entity, or to another location. The department shall not guarantee or be
liable for or responsible for guaranteeing the transfer of the license to any
other owner or other location. The existing
license shall be void and must be returned to the licensing authority when any
one of the following situations occurs:
(1) any
ownership interest in the facility changes;
(2) the
facility changes location;
(3) the
licensee of the facility changes; or
(4) the
facility discontinues operation.
B. Any owner or
applicant wishing to continue operation of an already licensed facility must
submit a new application for an initial license in accordance with these
regulations at least 30 days prior to the anticipated change and shall not be
guaranteed issuance of a license under the same terms and conditions of an
existing license. Failure by any owner
or new owner to apply for a new license under these conditions, while
continuing to operate under these regulations, shall be considered a violation
of these regulations and consent to the imposition of late fees, sanctions or
other actions for operating without a license, allowed under these regulations
and all other applicable statutes and regulations.
[7.10.2.16
NMAC - N, 3/1/2016]
7.10.2.17 AUTOMATIC EXPIRATION OR
TERMINATION OF LICENSE:
An existing license shall automatically expire at midnight on the day
indicated on the license, unless it is renewed sooner or it has been suspended
or revoked. If a facility discontinues
operation, is sold, leased or otherwise changes any ownership interest or
changes location, the existing license shall automatically expire at midnight
on the date of such action. Failure by
any owner or new owner to apply for a renewal or new license, while continuing
to operate under these regulations, shall be considered a violation and consent
to the imposition of late fees, sanctions or other actions for operating
without a license, allowed under these regulations and all other applicable
statutes and regulations.
[7.10.2.17
NMAC - N, 3/1/2016]
7.10.2.18 SUSPENSION OF LICENSE WITHOUT
PRIOR HEARING: If immediate
action is required to protect human health and safety, the licensing authority
may act in accordance with Section 24-1-5 NMSA 1978, as amended, and suspend a
license pending a hearing, provided such hearing is held within five working
days of the suspension, unless waived by the licensee.
[7.10.2.18
NMAC - N, 3/1/2016]
7.10.2.19 GROUNDS FOR DENIAL OF INITIAL OR
RENEWAL LICENSE APPLICATION, SUSPENSION OR REVOCATION OF LICENSE, OR IMPOSITION
OF INTERMEDIATE SANCTIONS OR CIVIL MONETARY PENALTIES: An initial license application or a renewal
license application may be denied, or an existing license may be revoked or
suspended, or intermediate sanctions or civil monetary penalties may be imposed,
after notice and opportunity for a hearing, for any of the following:
A. failure to
comply with any provision of these regulations;
B. failure to allow
access to the facility and survey(s) by authorized representatives of the licensing
authority;
C. allowing any
person to work at the facility while impaired physically or mentally or under
the influence of alcohol or drugs in a manner which harms the health, safety or
welfare of the clients, newborns, staff or visitors;
D. allowing any
person, subject to all applicable statutes and regulations, to work at the
facility if that person is listed on the employee abuse registry or considered
an unemployable caregiver under the Caregivers Criminal History Screen Act, as
amended, and related regulations, as amended or has a felony conviction for:
(1) homicide;
(2) trafficking
controlled substances;
(3) kidnapping,
false imprisonment, aggravated assault or aggravated battery;
(4) rape,
criminal sexual penetration, criminal sexual contact, incest, indecent exposure
or other related sexual offenses;
(5) crimes
involving adult abuse, neglect or financial exploitation;
(6) crimes
involving child abuse or neglect;
(7) robbery,
larceny, burglary, fraud, extortion, forgery, embezzlement, credit card fraud
or receiving stolen property; or
(8) an
attempt, solicitation or conspiracy involving any of the felonies in this
subsection.
E. misrepresentation
or falsification of any information on application forms or on other documents
provided to the licensing authority or used by the licensing authority in
granting or renewing a license;
F. repeat
violations of these regulations or discovery of repeat violations during survey(s);
or
G. failure to
provide the required care and services specified in these regulations or
providing care and services beyond the scope of the facility’s license at the
facility;
H. the list above shall not limit the
department from imposing sanctions and civil monetary penalties under all
applicable statutes, regulations and codes.
[7.10.2.19
NMAC - N, 3/1/2016]
7.10.2.20 HEARING PROCEDURES: Hearing procedures for an administrative
appeal of an adverse action taken by the department against a facility's license
will be held in accordance with applicable rules relating to adjudicatory
hearings, including, but not limited to,,, 7.1.2 NMAC, as amended. A copy of the above regulations will be
furnished at the time an adverse action is taken against a facility’s license
by the licensing authority, if the regulations cannot be obtained from a public
website.
[7.10.2.20
NMAC - N, 3/1/2016]
7.10.2.21 FACILITY SURVEYS:
A. Application for licensure, whether
initial or renewal, shall constitute permission for unrestricted entry into and
survey of a facility by authorized licensing authority representatives at times
of operation during the pendency of the license application, and if licensed,
during the licensure period.
B. Surveys may be
announced or unannounced at the sole discretion of the licensing authority. If, at the time of a facility survey, a client
is in labor, birthing, or immediately postpartum, the survey may be rescheduled
at the sole discretion of the licensing authority without penalty to the
facility.
C. Upon receipt of
a notice of deficiency from the licensing authority, the licensee or his/her
representative shall be required to submit a plan of correction to the
licensing authority within 10 working days stating how the facility intends to
correct each violation noted and the expected date of completion. All plans of correction for state or federal
deficiencies, if any, shall be disclosed in compliance with applicable state or
federal statutes and regulations. A state
plan of correction is not confidential once it has been approved and is
admissible for all purposes in any adjudicatory hearing and all subsequent
appeals relating to a facility license, including to prove licensee compliance
violations.
D. The licensing
authority may at its sole discretion accept the plan of correction as written
or require modifications of the plan by the licensee.
[7.10.2.21
NMAC - N, 3/1/2016]
7.10.2.22 REPORTING OF INCIDENTS: All facilities licensed under these
regulations must comply with all incident intake, processing, training and reporting requirements
under these regulations, as well as with any and all other applicable statutes
and regulations. All
facilities shall report to the licensing authority any serious incidents or
unusual occurrences which have threatened, or could have threatened the health,
safety and welfare of the clients, including, but not limited to,,:
A. fire, flood or
other man-made or natural disasters including any damage to the facility caused
by such disasters and any incident which poses or creates any life safety or health
hazards;
B. any outbreak of
contagious diseases and diseases dangerous to the public health;
C. any human errors
by staff and employees which may or has resulted in the death, serious illness,
or physical impairment of a client or newborn or staff; and
D. abuse, neglect, exploitation,
injuries of unknown origin and other reportable incidents in accordance with 7.1.13
NMAC, as may be amended from time to time.
[7.10.2.22
NMAC - N, 3/1/2016]
7.10.2.23 QUALITY ASSURANCE, QUALITY IMPROVEMENT SYSTEM, INTERNAL QUALITY
COMMITTEE, EXTERNAL QUALITY COMMITTEE AND POLICIES AND PROCEDURES: Each facility shall establish and maintain policies
and procedures for quality assurance and quality improvement systems, as well
as an internal quality committee and an external quality committee.
A. Policies and procedures: The administrator shall establish written
policies and procedures which govern the facility’s complete operation. The facility shall ensure that these policies
are adopted, administered and enforced to provide quality health services in a
safe environment. At a minimum, the
facility’s written policies and procedures shall include how the facility
intends to comply with all requirements of these regulations and address:
(1) the
facility organization including the legal entity or organization which owns the
facility, any management companies or managers which manage the facility, the
identity and credentials of the administrator responsible for establishing
lines of responsibility and accountability for both licensed and non-licensed
staff, and the administrator’s responsibility to direct employees or
contractually retain qualified individuals providing fiscal management and all
operations in the facility, as well as maintaining records of disclosure of
conflicts of interest and all ownership interests and controlling parties;
(2) the
facility administration including designation of an administrator with
authority, responsibility, and accountability for overall administration and
operation, including plans for the administrator’s absence;
(3) the
maintenance of the facility, equipment and supplies including sterilization and
disinfection of supplies, equipment and instruments; cleaning of birthing room
after each use; inspection and maintenance of emergency equipment; maintenance
of emergency supplies; maintenance, upkeep and cleaning of the building(s) and
equipment; fire and emergency evacuation procedures; and proper disposal of
waste liquids used for cleaning contaminated areas;
(4) quality
of care and services including appropriate and inappropriate admission
criteria; client rights; client risk assessment; administration and preparation
of drugs; quality assurance and performance improvement programs; referral of
clients for additional services including, but not limited to,, laboratory and
sonography; transfer of clients to a hospital; ambulance transfer services; emergency
procedures and resuscitative techniques; aseptic techniques; infectious waste
and biohazard disposal in accordance with all applicable statutes and
regulations; and safe handling of the placenta for families requesting to keep
the placenta;
(5) staffing
and personnel including written job descriptions for all staff with necessary
qualifications consistent with these rules; minimum staffing and staff qualifications;
and staff development and evaluation;
(6) maintenance
of the client health record including protection of client confidentiality and
privacy as required by law; secure
release of medical information and records; and safe handling and storage of
client records including appropriate document destruction procedures; and
(7) research
procedures for any research being conducted at the facility in compliance with
these regulations.
B. Internal quality
committee: The internal quality committee
is comprised at a minimum of the administrator and clinical director. If the administrator and the clinical
director are the same person, another staff person with clinical experience
shall be made a member of this committee.
This committee shall establish and implement quality assurance and quality
improvement systems monitoring and
promoting quality care to clients through reviews that include chart review,
data collection, client satisfaction surveys, and other program monitoring
processes; data analyses; identification of areas for improvement; intervention
plans, including action steps, responsible parties, and response time; and,
evaluation of the effectiveness of interventions. The internal quality committee shall at a
minimum, implement a thorough chart review process, as defined in these
regulations, which considers and reviews outcome data analysis, targeted
concern and improvement areas, client satisfaction surveys, and evidence based
research to identify necessary quality improvement areas and processes. When areas of concern or potential problems
are identified by the committee, the facility shall act as soon as possible to
avoid and prevent risks to clients. The
internal quality committee shall take and maintain meeting minutes. The internal quality committee shall, at a
minimum, meet or convene:
(1) within
72 hours of every emergent or sentinel event to conduct an initial review and
follow-up; if the internal quality
committee consists of less than three people, the external quality committee
shall convene to review emergent and sentinel events;
(2) monthly
to document any significant events and any necessary quality care improvement
steps to be applied to future events;
(3) quarterly
for a detailed chart review, as provided in these regulations, of a minimum of five
charts consisting of a minimum of one chart for each midwife and physician practicing
at the facility; charts of all labor, postpartum, and newborn transfers; Apgar
scores less than seven at five minutes; hemorrhage greater than 1000 ml; and
any other significant problems encountered within the quarter;
(4) annually for review of policies and procedures,
including, but not limited to,,:
(a) environment
of care;
(b) testing and
maintenance of equipment according to manufacturer’s recommendations;
(c) housekeeping
procedures;
(d) infection
control procedures;
(e) privacy
and security processes;
(f) compliance
with policies and procedures for all emergency drills, including, but not
limited to,,, fire, maternal/newborn emergencies, power failures, and natural
disasters;
(g) evaluation
of maintenance policies and procedures for heat, ventilation, emergency lighting,
waste disposal, water supply, laundry, and nourishment station;
(h) annual
employee performance evaluations;
(i) clinical
practice guidelines; and
(5) submission
of an annual quality report to the external quality committee.
C. External quality committee: The facility shall establish an external
quality committee which includes the members of the internal quality committee,
an external peer reviewer or a clinical consultant and other healthcare
partners, if available. The external quality
committee shall meet at least quarterly and perform an in-depth peer review case
study on a minimum of five charts which include at a minimum one case for each midwife
and physician practicing at the facility. The external quality committee shall also review
the care of individual clients, targeted types of clients, and appropriateness
of the clinical practitioner’s judgment and management of the case under the
facility’s standards of care and policies, and make recommendations for care
improvements. The external quality
committee shall also discuss relevant evidence based research and make
recommendations relating to clinical practice guidelines to improve quality of
care.
[7.10.2.23
NMAC - N, 3/1/2016]
7.10.2.24 RISK ASSESSMENT, CLIENT ACCEPTANCE AND LABOR ADMISSION CRITERIA: All licensed facilities shall follow and maintain
written clinical practice guidelines which address, at a minimum, eligibility
for care, on-going eligibility, medical consultation, and transfer criteria in
accordance with the scope of practice authorized under each practitioner’s individual
license(s) to be reviewed and updated by the internal quality committee at
least annually.
A. Risk assessment: A licensed practitioner shall make risk
assessments of all clients that at a minimum include:
(1) an
initial assessment which documents the general health and eligibility of a
potential client and which includes a detailed medical, social and family
history, a physical examination, and routine prenatal labs; the assessment may
also include ultrasounds to determine whether the client meets the criteria for
the facility’s scope of care;
(2) completing,
maintaining, and documenting an initial risk assessment and an on-going risk
assessment in the client record which include compliance with admission
criteria prior to client acceptance and throughout the pregnancy with the
clinical director making the final determination of each client's risk;
(3) if
a client before 32 weeks gestation has failed to register for freestanding birth
center care and has not received prenatal care, the client shall not be
accepted for care at the facility unless the client obtains a medical
consultation outside of the facility, meets all other eligibility criteria, and
a written, signed exception is made by the clinical director on a case-by-case
basis;
(4) clear
documentation of referrals, consultations and transfers to other providers for
ineligible clients or medical transfers;
(5) assessing
each client's risk status on admission in labor and throughout labor for
continuation of services;
(6) whether
the facility will have adequate space and sufficient staff to support the
client newborn during labor, birth and postpartum;
(7) written
criteria for antepartum, intrapartum, postpartum and newborn acceptance and
transfer to a hospital which delineates the transfer process from the facility
to an accepting hospital; and
(8) limitations
on the number of active labor clients at the facility
to the number of birth rooms available at the facility.
B. Ineligibility
for admission: If any of the
following conditions exist, birth at the facility shall be considered
inappropriate or improper:
(1) breech
or non-vertex presentation at labor and delivery;
(2) gestation
less than 37 weeks or greater than 42 weeks;
(3) multiple
gestation;
(4) medication
controlled gestational diabetes mellitus; or
(5) vaginal
birth after cesarean (VBAC) candidates with more than one previous cesarean
section, previous incision that is not low transverse, placenta location,
anterior and low-lying over the old scar.
[7.10.2.24
NMAC - N, 3/1/2016]
7.10.2.25 CLIENT RIGHTS: All facilities licensed pursuant to these
regulations shall support, protect, and respect clients’ rights. Facility staff shall receive training on
client rights and demonstrate understanding and competence in the policies and
procedures regarding client rights.
Client rights will be posted or made available to facility clients in
English or their preferred language. The
method by which a client may register a complaint against the facility will be
posted or otherwise made available to clients.
The facility shall have and enforce policies and procedures which
guarantee:
A. the right to equal
service, regardless of race, gender, gender identity, religion, ethnic
background, sexual orientation, education, social class, physical or mental
handicap, or economic status;
B. the right to
considerate, courteous and respectful care from all staff;
C. the right to
complete information using terms the average client can reasonably be expected
to understand;
D. the right to
informed consent, full discussion of risks and benefits prior to any invasive
procedure, except in an emergency, and advice regarding alternatives to the
proposed procedure(s);
E. the right to
receive a written list of all services available, service costs and advanced
notice of any changes;
F. the right to
receive care that is consistent with current scientific evidence about benefits
and risks;
G. the right for
non-English speaking clients to obtain assistance in interpretation;
H. the right to
know the names, titles, professions and specific types and licenses held by the
facility staff to whom the client speaks to and from whom services or
information are received;
I. the right to
refuse examinations and procedures to the extent permitted by law and to be
informed of the health and legal consequences of any refusal;
J. the right of
access to the client's personal health records;
K. the right of
respect for the client's privacy;
L. the right of
confidentiality of the client's personal health records as provided by law;
M. the right to
expect reasonable continuity of care within the scope of services and staffing;
N. the right to
have the client's civil rights, cultural background and religious opinions
respected;
O. the right to
present complaints to the management of the facility without fear of reprisal;
and
P. the right to
examine and receive a full explanation of any charges made by the facility regardless
of source of payment.
[7.10.2.25
NMAC - N, 3/1/2016]
7.10.2.26 CLIENT HEALTH RECORD: The facility shall maintain client health
records in a legible, uniform, complete and accurate format that provides
continuity and documentation of maternal and newborn information which is
readily accessible to health care practitioners, while protecting
confidentiality, using a system that allows for reliable and safe storage,
retrieval and loss prevention. The
facility must use a record form appropriate for use by the practitioners in the
facility which contains the required information necessary for transfer to an
acute care maternal and newborn hospital.
A. Record contents: Each licensed facility must maintain a
medical record for each client which may be in a paper or electronic format but
which can be easily accessible, copied, provided, reviewed and transported in
the event of any emergency or transfer.
Every record must be accurate, legible and promptly completed. At a minimum, facility health records for
each client must include written documentation of the following:
(1) client
demographics;
(2) client
consent forms;
(3) pertinent
medical, social, family, reproductive and nutritional history;
(4) a
list of medications that are currently prescribed for the client, including any
self-administered over-the-counter medication or neutraceuticals, including
dose of medication, route of administration, and frequency of use;
(5) allergy
list;
(6) initial
physical exam;
(7) initial
and on-going risk assessment and status;
(8) laboratory,
radiology and other diagnostic reports;
(9) assessment
of the health status and health care needs of the client;
(10) evidence
of continuous prenatal care including progress notes;
(11) evidence
of prenatal educational resources;
(12) labor
and birth summary;
(13) postpartum
care with evidence of follow-up within 48 hours of birth;
(14) newborn
care and follow-up;
(15) appropriate
referral of ineligible clients and documentation of transfer of care;
(16) documentation
of any consultations, special examinations and procedures;
(17) discharge
summary and applicable instructions to the client;
(18) list
of staff present during labor, birth and postpartum;
(19) evidence
that client rights have been provided to each client; and
(20) consent
form for participation in research signed by the client, if applicable.
B. Client records maintenance:
(1) current client
records shall be maintained on-site and stored in an organized, accessible and
permanent manner, with copies easily accessible for review, transfers or in an emergency;
(2) the facility
shall have in place policies and procedures in compliance with applicable law,
for maintaining and ensuring the confidentiality of client records, which
include the authorized release of information from the client records; and the
retention and transfer of client records at closure or ownership changes;
(3) non-current
client records shall be maintained by the facility against loss, destruction
and unauthorized use for a period of not less than five years from the date of
discharge and be readily available within 24 hours of request; if, any other
applicable statutes or regulations require a longer term of record retention
than five years, the longer term shall apply to the facility.
C. Chart
review: At a minimum, a
chart review performed by the internal quality committee shall consider written
documentation of:
(1) appropriateness
of admissions and continuation of services;
(2) complete
client demographic information;
(3) signed
informed consent(s);
(4) appropriate
referral of ineligible clients;
(5) continuous
prenatal visits, beginning no later than 32 weeks;
(6) continuous
risk assessment throughout prenatal care and for admission in labor;
(7) appropriate
maternal and newborn follow-up after birth;
(8) appropriateness of diagnostic and
screening procedures;
(9) complete
initial history;
(10) complete
initial physical exam;
(11) complete
prenatal labs and screenings;
(12) appropriateness
of medications prescribed, dispensed or administered;
(13) documentation
of medical consultation, if indicated;
(14) appropriate
identification and management of complications;
(15) appropriate
transfer of care for maternal/fetal/newborn indications;
(16) compliance
with these rules;
(17) compliance
with policies, procedures and clinical practice guidelines for maternal and
fetal assessment during labor and postpartum;
(18) compliance
with evidence based standards of practice;
(19) effectiveness
of staff utilization and training;
(20) completeness
of client records;
(21) review
of the management of care of individual clients or targeted types of clients or
cases for the appropriateness of the clinical judgment of the practitioner(s)
in obtaining consultation and managing the case relative to standards of care
and policies; and make recommendations for any improvements of care; and
(22) review
and analyze outcome data and trends, and client satisfaction survey results.
[7.10.2.26
NMAC - N, 3/1/2016]
7.10.2.27 MINIMUM STAFFING REQUIREMENTS: Qualified and properly licensed professional
and clinical staff shall provide quality family centered maternal and newborn
care consistent with the scope of practice authorized under each individual practitioner's
license(s). Direct care staff shall have
access to consulting clinical specialists and support by administrative and
ancillary personnel consistent with the volume of clients enrolled for care and
the scope of services offered. The
facility shall maintain adequate numbers of professional and support staff on
duty, present on premises, and on-call to meet routine service demands, as well
as high service demands and emergencies in order to assure client safety,
satisfaction, and that no mother in active labor is unattended. The facility shall have on staff at a
minimum:
A. a midwife or
physician on duty whenever there is a client in the facility in active labor or
immediately postpartum;
B. a midwife or
physician on immediate call whenever clients are in the facility receiving
clinical services;
C. personnel trained
in the use of emergency equipment and in BLS and NRP must be on duty whenever a
client is within the freestanding birth center receiving clinical services; this
includes nighttime hours when clients are within the freestanding birth center
in labor or postpartum;
D. an on-site administrator managing
the daily operations and implementing the policies and procedures;
E. a clinical
director responsible for implementing facility clinical policies;
F. an internal quality
committee that ensures the effectiveness of the quality assurance and
performance improvement process at the facility; and
G. an external
quality committee that provides in-depth peer review.
[7.10.2.27
NMAC - N, 3/1/2016]
7.10.2.28 MINIMUM STAFF QUALIFICATIONS: The facility staff minimum qualifications shall
be:
A. Administrator qualifications: The administrator must:
(1) be
at least age 21;
(2) have
a high school diploma or general educational development (GED) certificate and
two years of administrative or management experience;
(3) be
a licensed healthcare professional; and
(4) if
not a licensed healthcare professional, be a forty percent or greater owner in
the facility with relevant business experience.
B. Clinical director qualifications: The clinical director shall be at least 21
years of age and must have the following qualifications:
(1) must
be professionally licensed in a health care field;
(2) must
have two years of birthing and labor experience; and
(3) must
have two years of experience performing risk assessments to determine low risk
pregnancy eligibility.
C. Other clinical staff qualifications: All other clinical staff must
have the following qualifications:
(1) must
be at least 18 years of age;
(2) must
be licensed, certified or trained appropriately for the care provided; prior to
providing direct client care, the clinical director shall verify qualifications
and competence;
(3) must
comply with any and all caregiver criminal history screening requirements and
not be currently shown on any federal or state caregiver disqualification lists
or certified nursing assistant (CNA) disqualification lists or the employee abuse
registry.
D. Staff at birth: In addition to any and all other requirements
for licensed professionals, each birth shall be attended by two persons
currently trained in:
(1) adult
cardiopulmonary resuscitation equivalent to American heart association class C
BLS; and
(2) neonatal
resuscitation endorsed by American academy of pediatrics/American heart association.
E. Direct service staff: Each staff member who provides direct medical
services to clients, such as physicians, midwives, nurses, nurse practitioners
and physician’s assistants, who are required to be licensed, registered or
certified by the state of New Mexico, must have a current license, registration
or certificate from the state of New Mexico at the time they provide the
services.
[7.10.2.28
NMAC - N, 3/1/2016]
7.10.2.29 STAFF RECORDS: At a minimum, staff records shall
include:
A. Personnel records: Each facility licensed pursuant to these
regulations must maintain complete written records for each staff member,
employee, contractor and volunteer working at the facility, that are available
for review upon request by the licensing authority. At a minimum, each person’s records must
contain the following:
(1) personal
identification and demographic information;
(2) all
qualifications;
(3) all
current license(s) and training certification(s), including inoculations, if
applicable;
(4) annual
performance evaluations;
(5) documentation
that the employee has read and received the personnel policies;
(6) documentation
of required occupational safety and health administration (OSHA) and Health Insurance
Portability and Accountability Act (HIPAA) training; and
(7) copy
of caregiver criminal history screening clearance letter for all applicable caregivers
including any volunteers acting as caregivers and documentation that the
employee abuse registry has been reviewed to verify the staff person or caregiver
is not a risk to client or newborn health, safety and welfare.
B. Staff scheduling
records: The facility must:
(1) keep
weekly or monthly schedules covering all services;
(2) document
in each client record all staff present at labor, birth and postpartum through
discharge; and
(3) keep
all schedules on file for a minimum of six months.
C. Staff evaluation and development: The facility must have written documented
policies and procedures for staff orientation, on-going staff development,
staff supervision and staff evaluation, which include but are not limited to
the following:
(1) client
and facility emergency and safety procedures;
(2) quality
assurance and performance improvement programs; and
(3) documentation
of staff compliance with current licensure, certification, training and
position requirements, including initial and annual training requirements.
[7.10.2.29
NMAC - N, 3/1/2016]
7.10.2.30 RESEARCH:
A. If a facility is
conducting research activities, the facility must have written policies and
procedures for conducting the research being done, documentation that the study
has received institutional review board (IRB) approval and a consent form for
each client involved in the research in the client's record.
B. When research is
conducted by the facility or by the employees or by affiliates of the freestanding
birth center or when the facility is used as a research site, such that the facility's
clients and staff are involved in or the subjects of research; the research
must be conducted by qualified researchers, having evidence in formal training
and experience in the conduct of clinical, epidemiologic or sociologic
research, in accordance with the written, approved research policies and
procedures, by staff trained to conduct such research and in a manner that
protects the client’s health, safety and right to privacy and the facility and
its clients from unsafe practices.
[7.10.2.30
NMAC - N, 3/1/2016]
7.10.2.31 PHARMACEUTICAL SERVICES:
A. One individual shall be designated
responsibility for pharmaceutical services to include accountability and
safeguarding.
B. Keys to the drug
room or pharmacy must only be made available to authorized personnel by the
individual having responsibility for pharmaceutical services.
C. Drugs and biologicals must be
stored, prepared and administered in accordance with acceptable standards of
practice, in compliance with all New Mexico state board of pharmacy
requirements and in compliance with any and all other applicable federal and
state statutes and regulations.
D. Outdated drugs
and biologicals must be disposed of in accordance with methods required by the
New Mexico state board of pharmacy.
E. Adverse
reactions and allergies to medications must be reported to the licensed
provider responsible for the client and must be documented in the client’s
record.
F. Blood products are
limited to those used to prevent isoimmunization during and after pregnancy and
shall only be administered by a properly licensed personnel acting within the
scope of their license.
G. Medication
administration shall only be performed by a licensed provider acting within the
scope of their license.
H. Blood, including
whole blood, packed red cells, plasma, cryoprecipitate, or other blood factors
may not be administered in a freestanding birth center facility.
[7.10.2.31
NMAC - N, 3/1/2016]
7.10.2.32 LABORATORY SERVICES:
A. A facility that provides on-site laboratory
services shall meet all current CLIA regulations and must have a CLIA certificate
appropriate to the level of testing (e.g., certificate of waiver, provider performed
microscopy (PPM) or certification for moderately complex testing or waiver).
B. A facility that
contracts out its laboratory services shall only contract with a laboratory
that meets all current CLIA regulations and has CLIA certificates appropriate
for all testing requested by the facility.
C. All lab test
results performed either at the facility, or by contract, or by other
arrangement must be entered into the client record(s).
D. All laboratory
procedures shall be conducted in accordance with acceptable standards of
practice.
E. Facilities that
provide laboratory services or collect specimens for testing by outside CLIA
laboratories must provide the following:
(1) laboratory
work counter(s) with a sink and electrical outlets;
(2) lavatory
or counter sink(s) equipped for hand washing, or alcohol-based hand sanitizer
to
decontaminate
hands;
(3) adequate
storage for lab supplies;
(4) specimen
collection facilities with a toilet and lavatory;
(5) blood
collection facilities shall have seating space, a work counter and hand washing
facilities;
(6) appropriate
storage facilities to ensure specimens are maintained at correct temperatures
and
to prevent any deterioration or contamination.
[7.10.2.32
NMAC - N, 3/1/2016]
7.10.2.33 INFECTION CONTROL:
A. The facility shall develop,
implement and enforce written infection control policies and procedures to
minimize the transmission of infection. Policies
shall include educational course requirements; decontamination, disinfection,
sterilization, and storage of sterile supplies; and cleaning and laundry
requirements.
B. The facility shall
provide sterilization equipment adequate to meet the requirements for
sterilization of critical items. Equipment
shall be maintained in accordance with the manufacturers’ specifications, and
operated to perform with accuracy, the sterilization of critical items. Live spore testing for the effectiveness of
sterilization will be performed as defined by facility policy. Devices such as steri-gauges or sterilization
tape will not be sufficient to assess the effectiveness of the
sterilizers. The facility shall have a
methodology to permit the backtracking of equipment use in case a sterilizer or
any other medical equipment fails.
C. Where cleaning,
preparation and sterilization functions are performed in the same room or unit,
soiled or contaminated supplies and equipment shall be physically separated
from the clean or sterilized supplies and equipment.
D. Each facility shall
have policies and procedures for the handling, processing, storing and
transporting of clean and dirty laundry.
E. All special
waste including blood, body fluids, placentas, sharps and biological
indicators, shall be disposed of in accordance with OSHA and the New Mexico environment
department standards for bio hazardous waste.
F. Each facility shall
have written policies and procedures on terminal cleaning of birthing rooms to
ensure infection control and client safety.
[7.10.2.33
NMAC - N, 3/1/2016]
7.10.2.34 EMERGENCY MEDICAL SERVICES: All freestanding birth centers
shall have a written policy regarding emergency transfer for clients or newborns
including emergency response personnel and accepting hospital facility which
shall be followed in the event of an emergency.
A. Each facility
must maintain and have easily accessible an emergency response cart(s) or
emergency response tray(s) to provide emergency lifesaving procedures for an
adult and newborn and comply with the following:
(1) emergency
response carts or trays shall be supplied with the drugs and biologicals
commonly used in life saving procedures, along with supplies and equipment determined
by the clinical director of the facility;
(2) each
emergency response cart or tray shall have lists of equipment and supplies to
be maintained and ready and for use as an inventory guide;
(3) emergency
response carts or trays must be replenished as supplies or equipment are used;
(4) emergency
response carts or trays shall be checked on a monthly basis for completeness
and a log maintained with date and by whom the check was made; and
(5) all
clinical staff must know the location of and be trained in the use of the emergency
response.
B. Provisions for emergency
calls:
(1) an easily accessible hard wired telephone
for summoning help, in case of emergency, must be available in the facility and
in the birthing room during a labor; and
(2) a
list of emergency numbers including, but not limited to,, fire department,
police department, ambulance services, local hospital and poison control center
must be prominently posted by the telephone(s).
[7.10.2.34
NMAC - N, 3/1/2016]
7.10.2.35 BUSINESS HOURS AND OPERATIONAL
RECORDS: The facility
shall post its hours of operation in
a public location that can be seen by clients and visitors both inside and
outside the facility. The facility shall
keep all operational reports and records on file at the facility and make them
available for review to document compliance with these regulations upon request
of the licensing authority. Business and
operational records shall include, but are not limited to:
A. names and
addresses of all license owners, controlling parties, management company, if
applicable, administrator, clinical director and all of the members of the
internal and external quality committees;
B. a copy of the
most recent version of the licensing regulations;
C. any and all
agreements and contracts with other health care providers to provide services;
D. the most recent
life safety and health surveys conducted by the licensing authority and any
variances or waivers granted;
E. the most recent
fire inspection report by the fire authority having jurisdiction;
F. a log of fire
and emergency evacuation drills conducted by the freestanding birth center;
G. a valid and
current state board of pharmacy drug permit;
H. the most recent
state board of pharmacy inspection of the drug room;
I. the most recent
CLIA certificate applicable for the type of specimens tested or waiver(s) for
any specimen testing;
J. a log tracking infection
control and sterilization processes demonstrating compliance with these
regulations and all other applicable statutes and regulations;
K. if applicable,
New Mexico environment department approval of private water system;
L. if applicable,
New Mexico environment department approval of private waste and sewage
disposal.
[7.10.2.35
NMAC - N, 3/1/2016]
7.10.2.36 BUILDING STANDARDS FOR
FREESTANDING BIRTH CENTERS: The
purpose of a freestanding birth centers is to establish a safe, homelike
environment for healthy women anticipating a low risk birth so long as there is
sufficient space, furnishings, equipment and supplies to comfortably
accommodate the number of families, mothers, newborns and infants served by the
facility and the staff necessary for providing the services.
A. The facilities
may be in a house or residential structure adapted or renovated for birth
center use, if allowed and approved by the local zoning authority.
B. If the facility
is based in an office building, consultation and examining rooms must be
separate from the dedicated birth room(s).
C. Freestanding
birth centers must comply with life safety code requirements in accordance with
the applicable national fire protection association (NFPA) 101 life safety code
edition. Birth centers may be classified
as business occupancies if their capacity is restricted to occupancy by fewer
than four active births at any one time and the physical layout shall not
render clients, not including infants, incapable of self-preservation.
D. All freestanding
birth center facilities licensed under these regulations must be accessible to
and useable by handicapped clients, employees, staff and visitors.
[7.10.2.36
NMAC - N, 3/1/2016]
7.10.2.37 MINIMUM FACILITY SPACE REQUIREMENTS: Each
facility shall include and provide sufficient space for the following areas:
A. Public areas: The facility shall provide in the public
areas:
(1) sufficient
parking space(s) for the public, each birthing room and each employee present
on any single shift;
(2) a
reception and information counter or desk;
(3) a
waiting area for visitors;
(4) convenient
and accessible wheelchair storage;
(5) convenient
and accessible drinking fountain or bottled water.
B. Administrative and work areas: The facility shall provide administration and
work areas including:
(1) general
or individual office(s) for business transactions, records, administrative and
professional staff;
(2) storage
for staff personal effects which can be locked in drawers or cabinets.
C. Toilets, lavatories and bathing facilities: All fixtures and plumbing in the facility
shall be installed in compliance with applicable state and local building codes
and shall include:
(1) a
toilet and sink in each birth room, and a tub or shower available for use by
the laboring mother within the facility;
(2) a separate toilet and sink for staff
use;
(3) at
least one public and visitor restroom conveniently located and accessible to
the handicapped which includes a toilet and sink;
(4) a
hand washing sink in all toilet rooms which shall be kept supplied with single
use or individual use towels for hand drying or provided with mechanical blower;
(5) automatic hand sanitizer units may be
used instead of a sink.
D. Nourishment station: A facility nourishment center shall be
provided and include the following:
(1) work
counter;
(2) sink;
(3) refrigerator;
(4) storage
cabinets; and
(5) equipment
for hot and cold nourishment; the nourishment area may be available for staff
use, and may within space limited facilities also function as the staff lounge.
E. Examination rooms: If prenatal or other health care is provided
at the facility, exam rooms shall be separated from the dedicated birth room(s)
and shall have:
(1) sufficient
size to accommodate the necessary equipment and personnel consistent with the
purpose of the room;
(2) all
walls in an exam room shall be a minimum of eight feet long; and
(3) a
hand washing sink shall be located in each exam room or immediately adjacent to
the exam room.
F. Birth rooms: The facility shall have one birth room
available for each client in active labor which is and includes:
(1) sufficient
size to accommodate necessary equipment and personnel consistent with the
purpose of the room;
(2) all
walls constructed to a minimum length of 10 feet long;
(3) birth
rooms and bathrooms located to provide for complete privacy during use;
(4) clear
floor space to permit unimpeded egress and access for emergency transportation
equipment;
(5) located
to provide unimpeded rapid access to a facility exit which accommodates
emergency transportation vehicles and equipment; and
(6) furniture
arrangement in the birth room that permits a minimum clear dimension of 36
inches on at least one side for the full length of the bed where birthing can
occur.
G. Equipment and supplies:
(1) Equipment:
The facility shall be equipped with all
necessary items and equipment needed to provide low-risk maternity delivery and
care, as well as all equipment available and ready to provide emergency medical
services, including emergency carts or emergency trays, in life threatening
events to mother and baby including, but not limited to,:
(a) cardiopulmonary
resuscitation (CPR) equipment, oxygen, positive pressure mask, suction,
intravenous (IV) equipment, equipment for maintaining infant temperature and
ventilation, blood expanders, and medications identified in professional staff protocols
to meet emergency needs of mother and baby at the facility and during transport
to an acute care setting;
(b) equipment
for performing standard screening, laboratory tests, and for sterilizing instruments
and other materials, including programs for regular inspection and training in
the use of resuscitation and other equipment as outlined in the policies and
procedures manual which shall be available on site at all times; and
(c) maintenance
of all equipment in accordance with manufacturer’s specifications.
(2) Supplies: The facility’s supply inventory shall be sufficient
to care for the number of childbearing women and families registered for care
at any one time.
H. Housekeeping and support areas: The facility shall provide housekeeping and
support areas, including:
(1) general
storage facilities for supplies and equipment;
(2) drug storage and administration areas
which comply with New Mexico board of pharmacy regulations;
(3) clean
storage consisting of a separate room, space or closet for storing clean and
sterile supplies;
(4) soiled
holding with separate collection, storage and disposal for all soiled materials
used and stored at the facility.
I. Laundry services: The facility shall provide laundry services for both facility use and client care, on
the premises or through laundry and linen services:
(1) on-site
laundry facilities shall be provided with necessary washing and drying
equipment;
(2) soiled
laundry shall be kept in a separate storage area from the clean laundry storage
area;
(3) soiled
laundry shall not be stored in the nourishment, kitchen or dining areas;
(4) in
facilities with four or more birthing rooms, washers shall be located in
separate rooms from the dryers and shall have negative air pressure from the
other rooms in the facility.
[7.10.2.37
NMAC - N, 3/1/2016]
7.10.2.38 MINIMUM SAFETY REQUIREMENTS: Each
facility shall comply with the following minimum safety requirements:
A. Exits:
(1) Each facility and each floor of the
facility shall have exits as required and permitted by current fire protection and
life safety codes adopted by the state.
(2) Exit
ways must be kept free from obstructions at all times.
(3) All
exit and exit access doors must be at least 36 inches wide and accommodate
wheelchairs.
B. Corridors:
(1) Minimum corridor width shall be three
feet where the occupancy load is less than 50, or three feet eight inches, if
the occupant load is greater than 50.
(2) Narrower
corridor widths may be allowed in staff areas not in the exit pathway if not in
conflict with applicable building or fire codes and approved by the licensing
authority prior to occupying the facility.
C. Doors and windows:
(1) All doors in
spaces occupied or used by clients shall be solid core and have a minimum width
of 32 inches wide and be a minimum of one and three-quarter inches thick.
(2) Each
birthing room must have an operable window or alternate means to provide
adequate ventilation and emergency egress.
D. Emergency
lighting: The facility shall provide
emergency lighting which:
(1) activates
automatically upon any disruption of electrical service;
(2) is
sufficient to illuminate paths of egress and exits in the facility; and
(3) for
facilities with four or more birth rooms, is located in each birth room.
[7.10.2.38
NMAC - N, 3/1/2016]
7.10.2.39 MINIMUM ENVIRONMENTAL REQUIREMENTS:
Each facility shall comply with the
following minimum environmental requirements:
A. Floors and walls: All finishes shall be kept clean and shall be
of the type that is appropriate for the cleaning methods and solutions used to
maintain a clean and safe environment.
(1) Floor material shall be
readily cleanable and wear resistant.
(2) In all areas subject to
wet cleaning, floor materials shall not be physically affected by liquid germicidal
or cleaning solution.
(3) Floors subject to traffic
while wet including showers and bath areas shall have a slip resistant surface.
(4) Wall finishes shall be
washable and in the proximity of plumbing fixtures, shall be smooth and moisture
resistant.
(5) In
areas subject to wet cleaning, the intersection of the floor and wall
shall be sealed with a coved base or a wood bases tightly sealed connection
without voids.
(6) Floor and wall areas
penetrated by pipes, ducts and conduits shall be tightly sealed to minimize entry
of rodents and insects. Joints of
structural elements shall be similarly sealed.
(7) Threshold and expansion
joint covers shall be flush with the floor surface to facilitate use of wheelchairs
and carts.
B. Water: The facility shall provide water in
sufficient quantity to support all services provided and shall:
(1) insure that if the water is obtained
from a private water system and not a publically approved system, the water
supply is inspected, tested and approved by the New Mexico environment
department or appropriate authority prior to licensure; the facility shall be responsible
for insuring that subsequent periodic testing and inspection of any private
water systems is made at intervals prescribed by the New Mexico environment
department or the legally responsible authority which oversees or inspects,
tests, and approves the specific system;
(2) provide
hot water at each hot water outlet at all times with hot water for hand washing
facilities, tubs and showers not exceeding 120 degrees Fahrenheit at the
delivery point.
C. Water heaters:
(1) Must be able to supply hot water to
all hot water taps within the facility at full pressure during peak demand
periods and maintain a maximum temperature of 120 degrees Fahrenheit.
(2) Must
be enclosed and separated from other parts of the building premises by construction
as required by applicable state and local building codes, if using fired fuel.
(3) Must
be equipped with an operable pressure relief valve (pop-off-valve) which is
tested on a schedule recommended by the manufacturer.
D. Sewage and waste
disposal: The facility shall provide
for proper sewage and waste disposal at all times including:
(1) If the facility sewage and liquid
waste system is not part of an approved public system, the private sewage
system must be inspected, tested and approved by the New Mexico environment
department prior to licensure. The
facility shall be responsible to insure that periodic testing or inspection of
its private sewage disposal systems is made as required by the New Mexico environment
department or the legally responsible authority which oversee or inspects the
specific system.
(2) If
municipal or community garbage collection and disposal services are not
available, the method of collection and disposal of the facility’s solid waste must
be inspected and approved by the New Mexico environment department or the
legally responsible authority which oversee or inspects the specific system.
(3) All
external garbage and refuse receptacles must be kept clean, durable, have tight
fitting lids, must be insect, rodent and animal proof, washable, leak proof,
and constructed of materials which will not absorb liquids.
E. Environmental services: The facility shall provide:
(1) A separate lockable storage area or
closet for environmental cleaning supplies.
(2) Proper
disposal of all liquids and waste resulting from cleaning contaminated areas.
(3) Proper
procedures shall be maintained, and techniques used, consistent with the
facility’s policies and procedures and applicable regulations for disposal of bio-waste
and sanitary disposal of all other wastes.
F. Cleaning:
(1) The
facility must be kept clean and free from offensive odors and accumulations of
dirt, rubbish, dust, and safety hazards.
(2) Deodorizers
must not be used to mask odors caused by unsanitary conditions or poor
housekeeping practices.
(3) Safe
and effective procedures for cleaning and sanitizing all facility areas and
equipment shall be followed consistently to safeguard the health of the
clients, staff, and visitors.
[7.10.2.39
NMAC - N, 3/1/2016]
7.10.2.40 MINIMUM LIGHTING AND ELECTRICAL
STANDARDS:
A. Electrical standards:
The facility shall provide that:
(1) all facility electrical sources,
supplies, and equipment comply with all applicable national, state and local electrical
codes;
(2) all
circuit breakers or fused switches provide electrical disconnection and over
current protection and are:
(a) readily
accessible for use and maintenance;
(b) set
apart from traffic lanes; and
(c) located
in a dry, ventilated space.
(3) all
panel boards servicing lighting and appliance circuits shall be on the same floor
and in the same facility area as the circuits they serve; and
(4) each
panel board shall be marked showing the service area of each circuit breaker or
fused switch.
B. Lighting:
The facility shall insure that:
(1) all
spaces occupied by people, machinery or equipment within buildings, at outside
building approaches and at parking areas have adequate lighting to prevent
injury;
(2) lighting
shall be sufficient to make all parts of an area clearly visible;
(3) lighting
fixtures shall be shielded as required by code;
(4) lighting
fixtures shall be selected and located for the comfort and convenience of the
clients, staff and public; and
(5) a
fixed or portable examination light shall be provided for all examination and
birth rooms.
C. Electrical cords and
electrical receptacles: Power strips may not be used as a substitute
for adequate electrical outlets in a facility.
Power strips may be used for a computer, monitor and printer. Power strips shall not be used with medical
devices. The facility shall take
precautions if power strips are used, including: installing internal ground fault and over-current
protection devices, preventing cords from becoming tripping hazards, and using
power strips that are adequate for the number and types of devices used. The facility shall take all necessary
precautions to insure power overloads and excessive power demands on any
circuit do not cause overheating or fire.
Ground fault circuit interrupter (GFCI) shall be installed in locations
near water sources to prevent electrocution of persons.
(1) All electrical cords and extension
cords must be:
(a) U/L
approved;
(b) replaced
as soon as they show wear;
(c) not
used under any circumstances as a general wiring method;
(d) plugged
into an electrical receptacle within the room where used and not be connected
in one room and extended to anything outside the room; and
(e) not
be used in series.
(2) Electrical
receptacles must be:
(a) installed
as required by applicable codes;
(b) appropriately
rated for each use and function; and
(c) any
use of wall mounted outlets to expand the receptacle capacity or to be used as
a surge protector and connected to any medical equipment is prohibited.
[7.10.2.40
NMAC - N, 3/1/2016]
7.10.2.41 MINIMUM HEATING, VENTILATION AND
AIR CONDITIONING STANDARDS:
The facility shall provide and maintain heating, ventilating and air
conditioning or air cooling systems sufficient to keep all facility occupants
comfortable which include but are not limited to:
A. Heating, air-conditioning or air
cooling, piping, boilers and ventilation equipment furnished, installed and
maintained to meet all requirements of applicable state and local mechanical,
electrical and construction codes.
B. Use of a heating
method that consistently provides a minimum indoor winter design capacity of 75
degrees fahrenheit with accessible temperature adjustment controls appropriate
for all occupants’ comfort.
C. A prohibition
against the use of unvented heaters, open flame heaters or portable heaters.
D. An ample supply of
outside air shall be provided in all spaces where fuel fired boilers, furnaces
or heaters are located to assure proper combustion.
E. All fuel fired
boilers, furnaces or heaters shall be connected to an approved venting system which
takes all combustion products directly to the outside air.
F. Adequate ventilation
at all times to provide fresh air and the control of unpleasant odors inside
the facility.
G. A one hundred
percent automatic cutoff control valve in event of pilot failure for all
gas-fired heating equipment.
H. A system for
maintaining all occupants’ comfort during periods of hot weather.
I. Protection of all
boiler, furnace or heater rooms from other parts of the building by
construction having a fire resistance rating of not less than one hour with doors
that open to the interior being self-closing with a three-quarter hour fire
resistance rating.
J. Filters having
efficiencies as required by state codes for all central ventilation and air
conditioning systems.
[7.10.2.41
NMAC - N, 3/1/2016]
7.10.2.42 FIRE SAFETY: All current applicable
requirements of state and local codes for fire prevention and safety must be
met by the facility including, but not limited to:
A. Fire clearance and
inspections: Each facility must
request from the fire authority having jurisdiction an annual fire
inspection. If the policy of the fire
authority having jurisdiction does not provide for annual inspection of the
freestanding birth center, the facility must document the date the request was
made and to whom. If the fire
authorities make annual inspections, a copy of the latest inspection must be
kept on file in the facility.
B. Staff fire safety training:
(1) All facility staff must know the
location of and be instructed in proper use of fire extinguishers and other
procedures to be observed in case of fire or other emergencies. The facility shall request the fire authority
having jurisdiction to give periodic instruction in fire prevention and
techniques of evacuation.
(2) Facility
staff must be instructed as part of their duties to constantly strive to detect
and eliminate potential safety hazards, such as loose handrails, frayed
electrical cords, faulty equipment, blocked exits or exit ways and any other
condition which could cause burns, fall, or other personal injury.
(3) Fire
and evacuation drills: The facility must
conduct at a minimum on a quarterly basis at least one fire drill and
evacuation drill. A log must be
maintained by the facility showing the date, time, number of staff
participating and outlining any problems noted in the conduct of the drill.
C. Evacuation plan and preparedness plans: Each facility must have a fire and
disaster evacuation plan conspicuously posted in each separate area of the
building showing routes of evacuation in case of fire or disaster or other
emergency, as well as a disaster preparedness plan in the event of man-made or
natural disaster.
D. Provisions for emergency calls: An
easily accessible hard wired telephone for summoning help, in case of
emergency, must be available in the facility and a list of emergency numbers, including,
but not limited to, fire department, police department, ambulance services and
poison control center must be prominently posted by the telephone(s).
E. Fire
extinguishers:
(1) fire extinguishers as approved by the
state fire marshal or fire prevention authority having jurisdiction must be
located in the freestanding birth center;
(2) fire
extinguishers must be properly maintained as recommended by the manufacturer,
state fire marshal or fire authority having jurisdiction; and
(3) all
fire extinguishers must be inspected yearly and recharged as specified by the
manufacturer, state fire marshal or fire authority having jurisdiction; all
fire extinguishers must be tagged, noting the date of inspection.
F. Alarm system: A manually operated, electrically supervised
fire alarm system shall be installed in each facility as required by applicable
national fire protection association (life safety code) 101 (NFPA 101). Facilities located in multi-story buildings
must have a fire alarm system as required by NFPA 101.
G. Fire
detection system: The facility must be equipped with
smoke detectors as required by the NFPA 101 (life safety code) and approved as
to number, type and placement in writing by the fire authority having
jurisdiction.
[7.10.2.42
NMAC - N, 3/1/2016]
7.10.2.43 INCORPORATED AND RELATED STATUTES, RULES AND CODES: The facilities that are subject to this rule
are also subject to other statutes, rules, codes and standards that may, from
time to time, be amended, including all authorizing statutes under which any
applicable regulations have been promulgated.
Applicable regulations include, but are not limited to the following:
A. Health Facility Licensure Fees and Procedures, New Mexico department
of health, 7.1.7 NMAC.
B. Health
Facility Sanctions and Civil Monetary Penalties, New Mexico department of
health, 7.1.8 NMAC.
C. Adjudicatory
Hearings for Licensed Facilities, New Mexico department of health, 7.1.2 NMAC.
D. Caregiver's
Criminal History Screening Requirements, 7.1.9 NMAC.
E. Employee
Abuse Registry, 7.1.12 NMAC.
F. Incident
Reporting, Intake Processing and Training Requirements, 7.1.13 NMAC.
[7.10.2.43
NMAC - N, 3/1/2016]
7.10.2.44 SEVERABILITY: If any section or provision or application of
these regulations is held to be invalid, the remainder and its application to
other situations or persons shall not be affected or interfere with the remaining requirements provided by these
regulations.
[7.10.2.44 NMAC - N, 3/1/2016]
HISTORY OF 7.10.2 NMAC:
[RESERVED]