CMS proposes dropping new maternity training rules and easing nursing home room standards

The Centers for Medicare & Medicaid Services proposed on November 5 a broad revision of the safety conditions that hospitals, nursing homes and other providers must meet to take part in Medicare and Medicaid. Nothing changes yet. The proposal's text, scheduled for publication on November 10, allows 60 days for public comment. Day 60 is Saturday, January 9, 2027, and Federal Register practice moves a weekend date to the next business day, so by our count comments would close on January 11. The published notice will set the date.

CMS says the package would save providers about $320 million a year and free more than 3.26 million staff hours.

Maternity rules reversed before they start

In a rule published in November 2024, CMS set its first conditions written specifically for hospital obstetric services. Two parts start January 1, 2027: staff training on maternal care, and obstetric quality programs that track outcomes and disparities and run at least one improvement project a year. CMS now proposes deleting both, for hospitals and critical access hospitals. It would also drop training requirements on transfer protocols and emergency readiness, which already apply. Other obstetric conditions on staffing and delivery of care would stay.

CMS says it is unlikely to finish before January 1 and would ask inspectors to focus on requirements that are not about to be revised.

Two CMS positions, two years apart

We are implementing these requirements in response to the ongoing maternal health crisis

That rule cited 22 maternal deaths per 100,000 live births in the U.S. in 2022, more than double the rate in most other high-income countries. CMS concluded then that the safety benefit of training outweighed the burden on hospitals.

The new text reaches the opposite result. It puts hospitals' cost, from its 2024 estimates, at $24.2 million a year for training and about $18.8 million a year for quality programs. It says hospital accreditation standards, board certification and voluntary courses are enough, and that the costs "could affect some hospitals' decisions to continue providing OB services at their current level," particularly in places with little maternity care. It notes that 60% of rural counties already have no hospital obstetric services, and it encourages hospitals to keep investing in training.

The commenters CMS cites for its change include physician groups and rural health advocates, and its obstetric sections name no one opposed. The question is not settled. The 2024 rule records objections, including that new rules could lead hospitals to close units, and support: many commenters backed using quality programs to address gaps in maternal care. In a September 2024 letter, the Center for Reproductive Rights told CMS it supported baseline obstetric conditions. This proposal is a day old. When we checked on November 6, the news page of the American College of Obstetricians and Gynecologists and the news page of the National Consumer Voice for Quality Long-Term Care showed no statement on it.

Nursing homes

CMS argues that renovation costs deter operators from reopening older buildings where care is scarce, and that the volume of notices keeps ombudsman offices from focusing on inappropriate discharges. It asks for comment on the risks and unintended consequences of the room change.

Elsewhere in the proposal

Hospitals offering maternity care would gain a new duty: informed consent and policies around birth tissue collection, including when families ask for tissue for cultural, religious or personal reasons. CMS would also adopt the 2024 editions of national fire codes and drop a rule requiring outside windows or doors in patient sleeping areas at hospitals and some other settings. A separate requirement for a window in nursing home bedrooms would stay.

The file code is CMS-3484-P, and regulations.gov is among the ways to comment. CMS would have to issue a further final rule before any of this applies.