CMS is introducing a new CoP for hospitals ( 482.59) and Critical Access Hospitals (485.649) offering obstetrical services outside of emergency departments (EDs). The goal is to ensure that these services are well-organized and adhere to nationally recognized standards for physical and behavioral health for pregnant, birthing, and postpartum patients. Hospitals and CAHs would be required to maintain protocols aligned with evidence-based, nationally recognized guidelines, although specific organizations’ guidelines are not mandated. The services should be consistent with the complexity of care provided at the facility, including outpatient services matching the quality of inpatient care.
Key provisions include:
Organization and Supervision: Obstetrical services must be integrated with the hospital, with patient care units (e.g., labor, delivery, and post-partum rooms) supervised by qualified professionals like experienced registered nurses, nurse midwives, or physicians.
Practitioner Privileges: The hospital must delineate obstetrical privileges for all practitioners, including non-physician providers like nurse midwives.
Delivery of Services: Obstetrical care must meet high medical practice and safety standards. The labor and delivery suites should be equipped with essential equipment such as call-in systems, cardiac monitors, and fetal monitoring.
Emergency Protocols: Facilities must ensure that equipment, supplies, and personnel are readily available for obstetrical emergencies and complications, following evidence-based guidelines.