(a) A Level III (Subspecialty Care). The Level III maternal designated facility must:(1) provide care for pregnant and postpartum patients with low risk conditions to significant complex medical, surgical or obstetrical conditions that present a high risk of maternal morbidity or mortality;(2) ensure access to consultation to a full range of medical and maternal subspecialists, surgical specialists, and behavioral health specialists;(3) ensure capability to perform major surgery on-site;(4) have physicians with critical care training available at all times to actively collaborate with Maternal Fetal Medicine physicians or Obstetrics and Gynecology Physicians with obstetrics training and privileges in maternal care;(5) have skilled personnel with documented training, competencies, and annual continuing education, specific for the population served;(6) facilitate transports; and(7) provide outreach education related to trends identified through the QAPI Plan, specific requests, and system needs to lower level designated facilities, and as appropriate and applicable, to non-designated facilities, birthing centers, independent midwife practices, and prehospital providers.(b) Maternal Medical Director (MMD). The MMD must be a physician who:(1) is a board-certified obstetrics and gynecology physician with obstetrics training and experience, or a board-certified maternal fetal medicine physician, both with privileges in maternal care;(2) demonstrates administrative skills and oversight of the QAPI Plan; and(3) has completed annual continuing education specific to maternal care, including complicated conditions.(c) If the facility has its own transport program, there must be an identified Transport Medical Director (TMD). The TMD must be a physician who is a board-certified maternal fetal medicine specialist or board-certified obstetrics and gynecology physician with privileges and experience in obstetrical care and maternal transport.(d) Program Functions and Services.(1) Triage and assessment of all patients admitted to the perinatal service.(A) Pregnant patients who are identified at high risk of delivering a neonate that requires a higher level of neonatal care than the scope of their neonatal facility must be transferred to a higher level neonatal designated facility before delivery unless the transfer is unsafe.(B) Pregnant or postpartum patients identified with conditions or complications that require a higher level of maternal care must be transferred to a higher level maternal designated facility unless the transfer is unsafe.(2) Provide care for pregnant patients with the capability to detect, stabilize, and initiate management of unanticipated maternal-fetal or maternal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a higher level of neonatal or maternal care.(3) Supportive and emergency care must be delivered by appropriately trained personnel for unanticipated maternal-fetal problems that occur requiring a higher level of maternal care, until the patient is stabilized or transferred;(4) An obstetrics and gynecology physician with maternal privileges must be on-site at all times and available for urgent situations.(5) A board-certified or board-eligible Maternal Fetal Medicine physician with inpatient privileges must be available at all times for inpatient consultation and arrive at the patient bedside within 30 minutes of an urgent request to co-manage patients.(A) When telehealth or telemedicine is utilized for maternal fetal medicine co-management for non-urgent inpatient situations where an in-person response is not required, the facility must have the following:(i) a written plan for the appropriate use of telehealth/telemedicine for inpatient hospital care that is compliant with the Texas Medical Board Telemedicine rules, Texas Administrative Code,