FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule - CMS-1771-P (Maternal Health)
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 declaring the week of April 11, 2022, Black Maternal Health Week.
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.
Proposed Establishment of a Publicly-Reported Hospital Designation to Capture the Quality and Safety of Maternity Care
In this proposed rule, CMS is proposing the establishment of a maternity care quality hospital designation to be publicly reported on a CMS website. This would be the first-ever hospital quality designation by HHS that specifically focuses on maternal health. Under this proposal, CMS would initially give this designation to hospitals that report “Yes” to the Maternal Morbidity Structural Measure finalized in the FY 2022 IPPS/LTCH PPS final rule for adoption in the Hospital Inpatient Quality Reporting (IQR) Program.
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 will be submitted by hospitals for the first time in May 2022. CMS will 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 proposed designation would initially be 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 would allow for use of data already reported in the Hospital IQR Program, thereby avoiding any additional data collection or reporting burden for hospitals.
Additional measures that would comprise the designation are expected to evolve over time. In future notice-and-comment rulemaking, CMS intends to propose a more robust scoring methodology for the 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 proposed in this rule, if finalized – the Cesarean Birth eCQM and Severe Obstetric Complications eCQM – 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 proposed publicly-reported hospital designation, CMS is requesting 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.”
CMS is specifically exploring how to address the U.S. maternal health crisis through existing policy and program requirements, including, but not limited to, the Conditions of Participation (CoPs) and through measures in CMS quality programs. In this proposed rule, CMS invites 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.
- FACT SHEET: Vice President Kamala Harris Announces Call to Action to Reduce Maternal Mortality and Morbidity, please visit: https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/07/fact-sheet-vice-president-kamala-harris-announces-call-to-action-to-reduce-maternal-mortality-and-morbidity/
- Quality, Safety, and Oversight Guidance Memo, please visit: https://www.cms.gov/files/document/qso-22-05-hospitals.pdf
- Description of the Maternal Morbidity Structural Measure, please visit: https://www.cms.gov/files/document/maternal-morbidity-structural-measure-specifications.pdf