The U.S. Department of Health and Human Services is proposing new policies to reduce maternal mortality and injury in the U.S., building on the maternal mortality blueprint the White House released in 2022.

Vice President Kamala Harris calls that blueprint “an unprecedented whole-of-government strategy to improve maternal care” in a Centers for Medicare & Medicaid Services news release Wednesday.

“Today, we are building on this critical work by proposing new policies that will strengthen maternal health and increase access to high-quality care for millions of women and children throughout the country,” she said.

The U.S. maternal mortality rate of 22.3 pregnancy-related deaths per 100,000 live births was more than 50% higher than the next closest rate among comparable high-income countries in a report released last month by the Commonwealth Fund. The report notes the U.S. “continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic.”

Particularly affected are Black and Native American women, as well as women in rural communities.

In addition to pregnancy-related deaths, many thousands of women suffer pregnancy-related injuries that they survive, though they may experience long-term complications. The National Institute of Child Health and Human Development reports that common complications related to pregnancy can include heart problems, diabetes, high blood pressure, infections (most often from cesarean delivery), blood clots, anemia, severe bleeding, nausea, vomiting, depression and anxiety.

The news release said proposed policies “would increase access to care and advance health equity.” The proposal includes codifying that children enrolled in Medicaid and in the Children’s Health Insurance Program, or CHIP, would have a year of continuous eligibility — a temporary change included in the Consolidated Appropriations Act of 2023 that Congress passed.

The report by Commonwealth notes that 80% of pregnancy-related deaths are believed to be preventable. Among the highlights:

  • Maternal mortality rates were lowest for Asian American women (13.2 per 100,000 live births) and highest for Black women (49.5 per 100,000 live births).
  • Close to two-thirds of maternal deaths in the U.S. occur postpartum, up to six weeks after the woman gives birth. “Compared to women in the other countries we studied, U.S. women are the least likely to have supports such as home visits and guaranteed paid leave during this critical time.” About 1 in 5 of the deaths occur during pregnancy and just over 1 in 8 on the day of delivery.
  • In the first week postpartum, hemorrhaging, high blood pressure and infection are the common contributors to maternal death. Cardiomyopathy is the leading cause of later deaths.
  • The report also noted that the U.S. and Canada have “the lowest supply” of OB-GYNs and midwives.

Per the Commonwealth Fund report, nearly 7 million women in the U.S. live in counties that have no birth centers or hospitals that offer obstetric care and that lack obstetric providers. “The shortage is expected to only get worse in coming years,” it notes.

Proposed policy changes

Among the policy proposals released Wednesday are an add-on payment for certain Indian Health Services and tribal facilities to boost their ability to access specific high-cost drugs, adding equity measures to ambulatory surgical center and rural emergency hospital quality program measures and reducing barriers that make it hard for those returning to communities from incarceration to enroll in or maintain their Medicare coverage.

The release said it’s the first time that “CMS is proposing baseline health and safety requirements for hospitals and critical access hospitals” for obstetric services. The proposal includes new requirements for maternal quality improvement, adding standards for the organization, staffing and delivery of care within obstetrical units, making emergency services available, and ensuring procedures for transferring obstetrics patients if needed. Yearly training of staff on evidence-based maternal health practices and cultural competencies are also among proposals.

“CMS is using all of our tools to improve the safety, quality and timeliness of the care that hospitals provide to pregnant women,” Dr. Dora Hughes, acting CMS chief medical officer and acting director for CMS’ Center for Clinical Standards and Quality, said in a written statement.

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The proposed rule also aims to reduce opioid overdoses and ensure effective pain control by implementing provisions in the act that provide access to non-opioid treatments for pain management. And it would separately fund access to six drugs and a device that are non-opioid pain treatments in hospital outpatient departments and ambulatory surgical centers.

Additionally, Indian Health Services and tribal clinics would be able to bypass the “four walls” rule for Medicaid clinic services offered by behavioral health clinics and other clinics in rural areas.

The 2022 White House blueprint

The blueprint released in 2022 lists five goals to improve maternal care and reduce deaths and injuries related to pregnancy:

  • Improving access to and coverage of comprehensive quality maternal health services, including behavioral health.
  • Making sure the women giving birth are listened to and included in decision-making and holding care systems accountable for that.
  • Enabling better data collection, transparency and research on maternal health issues.
  • Enlarging and diversifying the perinatal workforce.
  • Bolstering financial and emotional supports before, during and after pregnancy.

The public comment period on the proposed policies ends Sept. 9. The proposed rule in its entirety is available in the Federal Register here.

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