The U.S. is experiencing a serious maternal health crisis, with a mortality rate that is among the highest in high-income countries and is particularly high for Black women. According to The Commonwealth Fund, in 2022, Black women in the U.S. experienced 49.5 maternal deaths per 100,000 live births, while white women experienced 19 deaths per 100,000 live births. The rates in the U.K. are 5.5 deaths per 100,000 live births, in Canada it’s 8.4 per 100,000, and Norway reported zero.
According to the Centers for Disease Control and Prevention, 80% of maternal deaths are preventable through improvements in patient, family, provider, facility, system, and community factors. Effective January 1, 2025, the Centers for Medicare and Medicaid Services (CMS) launched the CY 2025 Hospital Outpatient Prospective Payment System (OPPS) final rule, establishing new maternal health and safety standards for hospitals to reduce maternal mortality.
“We face a significant maternal mortality and morbidity crisis caused by disparities in care, environments that don’t support healthy lifestyles, unequal access to quality health care in both urban and rural areas, and a shame-and-blame attitude toward the poor and vulnerable,” said Lora Sparkman, MHA, BSN, RN, Partner, Clinical Solutions, VP Patient Safety and Quality at Relias. “One action we can take now is educating and training obstetric frontline caregivers on standards of care and the latest evidence explaining why birthing people die or are harmed during or after delivery. Variation in care at the provider and system levels results in poor maternal health outcomes. Awareness, attention, accountability, and action are the solutions — and they start with competent, well-trained clinical teams.”
New CMS Maternal Health Standards
CMS has established new health and safety requirements for hospitals and CAHs that provide obstetrical services. These requirements set baseline standards for the organization, staffing, and delivery of care within obstetrical units, update the quality assessment and performance improvement (QAPI) program, and mandate staff training on evidence-based maternal health practices.
Organization and staffing
CMS’ new requirements aim to ensure that obstetric services are properly organized and follow nationally recognized standards of practice for caring for pregnant, birthing, and postpartum patients. This includes coordinating OB services with other departments, having qualified individuals oversee OB patient care units, and granting OB privileges based on written criteria for all practitioners.
Delivery of service
Hospitals and critical access hospitals (CAHs) that offer OB services must have essential equipment, such as a call-in system, cardiac monitor, and fetal Doppler/monitor, readily available to meet patient needs. The equipment should be stocked according to the facility’s scope, volume, and complexity of OB services. Moreover, facilities need to have proper provisions and protocols for OB emergencies and complications, in line with nationally recognized guidelines.
Staff training
Hospitals and CAHs must establish policies and procedures to ensure that relevant staff are trained on topics aimed at enhancing maternal care delivery. Training should align with the scope and complexity of services provided and be guided by findings from Quality Assessment and Performance Improvement (QAPI) programs. New staff must undergo initial training, and relevant staff are required to complete refresher training every two years. Documentation of training completion must be maintained in staff personnel records.
Quality assessment and performance improvement (QAPI) program
Hospitals and CAHs providing OB services must use their QAPI programs to assess and improve health outcomes and disparities among OB patients. This involves analyzing data and quality indicators for diverse subpopulations, measuring and tracking patient outcomes and disparities, and performing at least one performance improvement project each year. Facilities should also incorporate publicly available information from Maternal Mortality Review Committees into their QAPI programs if accessible.
Emergency services’ readiness
Hospitals and CAHs must have proper provisions and protocols for emergencies, and relevant staff must be trained on these protocols every year. Hospitals must also allocate emergency supplies, including medications, blood products, and lifesaving equipment.
Transfer protocols
Hospitals must establish written policies and procedures for transferring patients under their care, including intra-hospital and inter-hospital transfers. To promote safe and uniform patient transfers and keep staff updated on any protocol changes, hospitals are required to provide annual training to relevant staff on these transfer procedures.
Who must comply: Scope and applicability
These conditions of participation (CoPs) apply to hospitals and CAHs that offer obstetric services and participate in Medicare or Medicaid. Compliance with these CoPs is required to retain federal funding eligibility.
Why this matters to executives and boards
- Compliance risk: Failure to meet these CoPs may threaten Medicare and Medicaid participation, which is a major concern for revenue and reputation.
- Quality and value-based care: Embedding maternal-focused QAPI and training enhances safety outcomes, supports quality metrics, and positions hospitals for success within value-based care frameworks.
- Health equity imperatives: The U.S. maternal mortality crisis is deeply inequitable. Black, American Indian, and Alaska Native people, along with other marginalized groups, face disproportionately higher mortality and morbidity rates. These CoPs, which focus on outcome tracking and improvement, offer a structural path to address these disparities.
Transform regulations into opportunity
Hospital leaders can turn this regulatory mandate into a transformative opportunity:
- Assess current readiness: Perform a gap analysis across emergency protocols, staff training, QAPI programs, staffing, and infrastructure.
- Designate a compliance champion: Entrust oversight to an OB unit director or quality governance leader to coordinate implementation.
- Plan for phased implementation: Focus on Phase 1 readiness — ensure emergency protocols and transfer systems are in place. Build toward organizational standards, staffing, QAPI integration, and training for Phases 2 and 3.
- Prioritize equity: Embed health equity into QAPI projects — monitor disparities, partner with local organizations, and tailor services to marginalized populations.
Final thoughts
By proactively meeting these new maternal health standards, you can ensure compliance and show a strong commitment to safer, more equitable care for birthing people across communities. These efforts not only improve patient outcomes but also position your facility as a leader in maternal health. Continuous improvement and consistent adherence to these standards will help your facility stay at the forefront of providing high-quality, compassionate care. Embracing these changes is not just about meeting regulatory requirements; it’s about making a lasting positive impact on the lives of mothers and their families.