What began as a way to help neonatal intensive
care units (NICUs) in Texas meet level of care standards has led to a multidisciplinary AAP pilot program with the potential to expand across the U.S.
and to other pediatric fields.
The AAP NICU Verification Program is an opportunity for the Academy to help NICUs in Texas achieve the best outcomes for every high-risk
newborn, regardless of insurance. The verification
process is required of NICUs in Texas for state designation and mandatory for NICUs that provide
care to Medicaid patients.
It is one of two state-approved programs to survey
whether the level II, III and IV NICUs meet neonatal
care standards outlined in Texas administrative code.
The NICU Verification Program leadership team
is excited to see the Academy’s guidance put into
action, said Ann R. Stark, M.D., FAAP, medical
director of the NICU Verification
Because the AAP Levels of Neonatal Care policy and Guidelines for
Perinatal Care are considered the
gold standard for NICUs, Texas
used these tools to help shape its
code, said Dr. Stark, who wrote the
first Levels of Neonatal Care policy in 2008. The AAP policy provides evidence for
tiered provision of care with consistent standards for
resources and personnel at four levels, according to
an infant’s gestational age and illness severity.
Texas previously allowed hospitals to self-des-ignate the level of care their NICU offered. Now,
NICUs will start the three-step verification process
by applying on the AAP website, http://www.aap.
org/nicuverify. After completing a comprehensive
pre-review questionnaire, they host a site visit from
a multidisciplinary team, receive feedback and verification, and apply to the state for designation. The
process repeats every three years.
The program has the potential to help NICUs
nationwide verify that they are meeting AAP standards, Dr. Stark said. She noted that substantial published evidence shows that survival
of preterm babies is increased and
morbidity is decreased when they
receive risk-appropriate care.
Texas legislators became interested in NICU costs and quality
after an Austin legislator’s baby
received care in a Texas NICU,
said Charles T. Hankins, M.D.,
FAAP, a NICU Verification Program member and
chief medical officer at Texas Children’s Hospital
“They started looking at it as a value proposition,”
he said. Legislators wanted to ensure that facilities
were able to meet the needs of babies. “The Texas
Medicaid program is the largest payer of newborn
claims, and this program is hoped to improve the
outcomes while stabilizing costs,” he said. About 52%
of babies are covered by the Medicaid program.
A Perinatal Advisory Council worked with the
Texas Department of State Health Services to de-
velop criteria for levels of care and the process for
NICU leaders are encouraged to begin the site
survey and verification process before May 2018.
NICUs must receive state designation by September
2018. Verification can be sought through the Academy’s program or the Texas EMS Trauma & Acute
Four level IV NICUs have undergone verifica-
tion and received the necessary documentation for
designation. The leadership team is continuing to
AAP NICU Verification Program starts small, looks to grow
• NICU Verification Program, http://www.aap.org/nicu
• AAP policy Levels of Neonatal Care, http://bit.ly/2lb Gp2R
• Guidelines for Perinatal Care, 7th edition, http://bit.