FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Final Rule

A Commitment to Improving Maternal Health in the U.S.

The Biden-Harris Administration is committed to achieving a government-wide vision that addresses the maternal health crisis in the U.S., including by reducing maternal mortality and morbidity and advancing maternity care quality, safety, and equity. As a part of this commitment, the White House held the first-ever federal “Maternal Health Day of Action” on December 7, 2021, at which time Vice President Kamala Harris issued a national call to action to Reduce Maternal Mortality and Morbidity. In addition, the U.S. Department of Health and Human Services (HHS) — through the Centers for Medicare & Medicaid Services (CMS) — announced critical steps to improve maternal health by supporting the delivery of equitable, high-quality care for all pregnant and postpartum patients. The White House also issued presidential proclamations on April 8 and April 13 in recognition of Black Maternal Health Week, which occurred the week of April 11 in 2022.

Specifically, CMS shared intentions to pursue rulemaking for the establishment of a publicly-reported hospital designation to drive improvements in maternal health outcomes and advance maternity care quality, safety, and equity. CMS followed this announcement with a guidance memo encouraging hospitals to consider implementation of evidence-based best practices for the management of obstetric emergencies, along with interventions to address other key contributors to maternal health disparities.

The Biden-Harris Administration Blueprint to Address the Maternal Health Crisis released in June 2022 stated intent to explore opportunities to advance equitable, high-quality maternity care provided by hospitals in several ways, including through this hospital designation and through the FY 2023 President’s Budget, which would support a perinatal quality collaborative in every state.

Establishment of a “Birthing-Friendly” Hospital Designation

To build on the White House Blueprint for Addressing the Maternal Health Crisis, CMS will establish a “Birthing-Friendly” hospital designation — a publicly-reported, public-facing hospital designation on the quality and safety of maternity care. This is the first-ever hospital quality designation by HHS that specifically focuses on maternal health. CMS is establishing this hospital designation in Fall 2023. This proposal was made in conjunction with Vice President Harris’ nationwide call to action to reduce maternal mortality and morbidity, which included CMS’ intention to establish this proposed hospital designation. As finalized, CMS will award this designation to hospitals that report “Yes” to both questions in the Maternal Morbidity Structural Measure, reporting that the hospital participated in a national or statewide quality collaborative and implemented all recommended interventions.

The Maternal Morbidity Structural Measure is an attestation specified to capture whether hospitals are: (1) participating in a structured state or national Perinatal Quality Improvement (QI) Collaborative; and (2) implementing patient safety practices or bundles as part of these QI initiatives. The reporting period for the measure began in October 2021, and data were submitted by hospitals for the first time in May 2022. CMS plans to post measure data for October to December 2021 on the Care Compare website in Fall 2022, and post initial results for the hospital designation beginning in Fall 2023.

Expansion of Designation Components

As stated above, the designation is initially based only on data from hospitals reporting an affirmative attestation to the Maternal Morbidity Structural Measure. In addition to capturing hospital implementation of best practices in maternity care, this approach allows for use of data already reported in the Hospital IQR Program, thereby avoiding any additional data collection or reporting burden for hospitals.

CMS sought and received comments on potential future components for the designation. In future notice-and-comment rulemaking, CMS intends to propose a more robust designation that may include other maternal health-related measures finalized for the Hospital IQR Program measure set. Other potential measures could include the two electronic clinical quality measures (eCQMs) being finalized in this rule — the Cesarean Birth eCQM and Severe Obstetric Complications eCQM — as well as additional future measures that are equity-focused, and/or measures that capture patient-reported outcomes or experiences of care.

Ultimately, CMS’ goal is not simply to grant hospitals a maternal health “gold star,” but to do so in a way that is meaningful for patients and families in search of facilities with a demonstrated commitment to the delivery of high-quality, safe, and equitable maternity care.

Request for Information to Advance Maternal Health Equity

In addition to the publicly-reported hospital designation, CMS requested feedback on additional ways the agency can advance equity and reduce disparities in maternity care.

CMS defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”

In the proposed rule, CMS specifically sought comment on how to address the U.S. maternal health crisis through existing policy and program requirements, including, but not limited to, the Conditions of Participation (CoP) and through measures in CMS quality programs.  CMS invited and received public comment on the potential use of such approaches as well as on best practices in maternal health data collection and reporting, community engagement and partnerships, assessment of patient experiences, and prevention of racism and bias in maternity care. A summary of these comments is provided in the final rule and will be used to inform potential future policy development.

FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Final Rule