Updated Sept. 7, 4:30 p.m. A wave of hospitals in Texas have applied to have their neonatal intensive care units designated by the state following legislation that was passed in 2013. Baylor Scott & White Medical Center – Frisco and Baylor Scott & White Medical Center – Centennial are among the hospitals seeking to designate their NICUs. Hospitals had until Sept. 1 to receive a designation in order to continue receiving Medicaid reimbursements. Nearly 4,000 babies in Collin and Denton counties were delivered through the Medicaid program in 2016, according to Texas Health and Human Services. As of Sept. 7, Baylor Scott & White Medical Center – Centennial had received a Level II designation. Baylor Scott & White Medical Center – Frisco had not received its designation yet, according to the Texas Department of State Health Services website. The new designations help keep hospitals accountable and ensure each NICU is being measured under the same standards statewide, said Debbie Lightfoot, a Texas Department of State Health Services neonatal designation coordinator. “Hospitals were advertising they were at a certain level when they really weren’t,” she said. “These standards put forth for the designations will ensure patients get the outcomes they expect when choosing a hospital.”

Designation levels

Hospitals can apply for one of four levels of designation. According to the state, Level IV, or advanced, NICUs provide care for mothers and their infants of all gestational ages with the most complex or critical illnesses. Level IV NICU infants may require life support. Level III NICUs also care for infants of all gestational ages but treat illnesses anywhere from mild to critical. Level II NICUs care for infants that are at or older than 32 weeks gestational age, and Level I NICUs care for infants that are at or older than 35 weeks gestational age. Both Frisco Baylor Scott & White hospitals were pursuing a Level III designation, but Baylor Scott & White Medical Center – Centennial ended up receiving a Level II designation. At least one Baylor Scott & White hospital in Frisco has referred to its NICU in the past as having Level III features, even before receiving a state designation. Ellen Hansen, Baylor Scott & White chief operating officer, said the hospital system previously looked at other states’ designation levels to determine which designation level would best fit each hospital’s features. “While the state of Texas has just started designating its NICUs, many other states across the country have done this for decades,” she said. “… Because other states had designations, we loosely understood what a Level I, II, III or IV NICU would be. So we were able to just state that we were a Level III NICU at Frisco because we knew we met the general criteria that a Level III in another state would meet,” Hansen said. Texas Health Frisco, which is expected to open in 2019, also plans to pursue a Level III NICU designation. “We will be able to accommodate most moms and babies in our welcoming, comfortable new space, which will include the latest equipment,” said Dr. Elizabeth Ransom, executive vice president at Texas Health Resources and zone clinical leader. Medical City Frisco’s NICU is expected to open this fall. Because the hospital is a branch of Medical City Plano, its NICU does not have to apply for a separate designation, said Sandi Gill, Medical City Frisco chief nursing officer. The NICU will begin as a Level II but may go up to a Level III after a year, she said. “Frisco is a young, thriving community, and the demographics match the need for us to have capabilities so that people can stay within their home town and not have to go south of here to get care,” Gill said.

Designation process

To obtain a designation, hospitals must have an organization approved by the Office of Emergency Medical Services conduct a site visit. The organization will recommend a designation level for the hospital to seek. Hospitals then have to submit an application packet to the Office of Emergency Management within 120 days of the site visit. Designations must be renewed every three years, but a hospital can request a change in designation at any time. Chris Van Deusen, DSHS director of media relations, said there is not a typical turnaround time for reviewing NICU applications but said all the applications that were received by July 1 would be processed by Sept. 1. Hansen said both of Frisco’s Baylor Scott & White hospitals have applied for a designation and have had the NICUs surveyed. “Formalizing this process I think is the best thing for our mothers and our babies and their care so that the public can be reassured that we do have the things in place to take care of them,” said Becky Hardie, vice president for Women’s and Infant’s Services at Baylor Scott & White Health. Sherelle Black contributed to this story.