Hospital neonatal services in the United States: Variation in definitions, criteria, and regulatory status, 2008

The purpose of this study was to describe variation among states in designations of hospital neonatal services levels.Study Design:We systematically searched all 50 states and District of Columbia governmental web sites and extracted definitions and levels terminology, functional and utilization criteria, regulatory compliance and funding measures, and citation of American Academy of Pediatrics (AAP) documents on levels of neonatal care.Result:Thirty-three states designate multiple graduated levels of neonatal services. Two to six levels were designated by numbers, titles, or both. Regulatory sources include hospital licensure, Certificate of Need or State Health Plan (CON/SHP), State Health Department, or an affiliated non-governmental entity (SHD/affiliate). Twenty-four states have a single source and nine have two or more. Functional criteria include population characteristics, respiratory care capabilities, and neonatal and cardiac surgery in 25 states. Utilization criteria include capacity, volume, occupancy, or case mix. Compliance mechanisms include license renewal, CON/SHP approval, and/or SHD/affiliate certification. Thirteen states link funding for the highest level of care through Medicaid, Maternal Child Health Title V funds or regional programs. AAP documents are cited or incorporated by reference in 22 states.Conclusion:All states regulate health care services and facilities. Definitions, criteria, compliance mechanisms, and regulatory source and status of neonatal levels of service vary widely. A consistent national approach would facilitate comparisons in neonatal outcomes and resource use and be informative to parents, providers, and policy makers. AAP documents could serve as a mechanism to foster such consistency.