CMS Issues Proposed Rule to Integrate Equity and Maternal Health Quality Measures into Payment for Hospitals

By Joy Burkhard, MBA

On April 19, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (aka regulation) to expand on key priorities of advancing maternal health and health equity in maternal health care.

The proposed rule addresses actions inpatient and long-term hospitals must take to improve maternal health in delivery settings and ties those actions to Medicaid reimbursement. The 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule includes:

three health equity-focused measures in hospital quality programs (not specific to maternal health care),
seeks stakeholder input related to documenting social determinants of health in inpatient claims data (not specific to maternal health care), and
proposes a “BirthingFriendly” hospital designation.

For hospitals paid under LTCH/IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users, the proposed increase in operating payment rates is projected to be 3.2%. CMS expects to increase payments to hospitals paid under PPS, by approximately 0.8% or $25 million.

More About the New The “Birthing-Friendly” Hospital Designation

If the proposed rule is finalized as written the new “Birthing Friendly” designation would assist consumers in choosing hospitals that have demonstrated a commitment to maternal health through the implementation of best practices that advance health care quality, safety, and equity for pregnant and postpartum patients. Initially, the designation would be awarded to hospitals by CMS based on their attestation to the Hospital IQR Program’s Maternal Morbidity Structural Measure. Data would be submitted by hospitals for the first time in May 2022, and CMS will post data for October to December 2021 in fall 2022. The hospital designation would begin in fall 2023.

The proposed rule also introduces two additional quality measures for the Hospital IQR Program intended to drive improvements in maternal health, including a measure of low-risk Cesarean deliveries and a measure of severe obstetric complications.

Criteria for the designation could be expanded in the future. 2020 Mom plans to continue to work with CMS to promote maternal mental health in these structures, including referencing the “Whole Mom” hospital maternal mental health standards.

More About The General Hospital Health Equity Measures

To address health care disparities in hospital inpatient care and beyond, CMS is proposing health equity-focused measures for adoption in the Hospital Inpatient Quality Reporting (IQR) Program:

Commitment to establishing a culture of equity and delivering more equitable health care by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement.
The second and third measures capture screening and identification of patient-level, health-related social needs—such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. By screening for and identifying such unmet needs, hospitals will be in a better position to serve patients holistically by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.

For a CMS fact sheet specific to the maternal health and health equity measures included in the proposed payment rule visit: https://www.cms.gov/newsroom/fact-sheets/fy-2023-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospitals-ltch-pps-0

CMS finalized these rules in August 2022. You can learn more about the final rules here.