Hospitals that deliver babies will soon have to tell Medicare not just that they belong to a maternal safety network, but which one. The Centers for Medicare & Medicaid Services finalized the change on July 31 as part of its annual inpatient payment rule.
The update applies to the Maternal Morbidity Structural measure inside the Hospital Inpatient Quality Reporting Program, and it takes effect beginning with the fiscal year 2028 payment determination. According to the CMS fact sheet, hospitals will need to "identify which perinatal quality collaborative the hospital participates in."
On its face this is a paperwork adjustment. In practice it converts a yes-or-no attestation into a verifiable claim, and that distinction matters for anyone who has ever tried to compare two hospitals before a delivery and found the published information too vague to act on.
The Change CMS Finalized
The Maternal Morbidity Structural measure has been part of Medicare's hospital quality reporting since it was adopted several years ago. It asks hospitals two things: whether they participate in a structured state or national perinatal quality collaborative, and whether they are implementing the patient safety practices or bundles that come with those initiatives.
Until now, a hospital could answer yes without saying where. Starting with the FY 2028 payment determination, the answer has to include the name of the collaborative.
The measure is not decorative. Hospitals that fail to meet Inpatient Quality Reporting Program requirements face a one-fourth reduction in their annual payment update under the inpatient payment system. The measure also feeds the Birthing Friendly designation that appears on Medicare's public hospital comparison tools, which is how the data reaches consumers.
CMS had signaled the change in its proposed rule in April and finalized it without altering the substance. The broader rule, posted to the Federal Register, sets a 2.3 percent increase in inpatient payment rates for FY 2027 and makes numerous other quality program changes.
Inside a Perinatal Quality Collaborative
Most readers have never heard the term, which is part of why naming the collaborative is useful.
The CDC describes perinatal quality collaboratives as state or multistate networks of multidisciplinary teams working to improve maternal and infant care and outcomes. They bring together hospitals, clinicians, patients and public health agencies to spread specific practices, using shared data to track whether the practices are actually being followed. The CDC currently supports 36 state-based collaboratives and funds a national coordinating network.
The concrete work usually involves patient safety bundles developed through the Alliance for Innovation on Maternal Health, a national program led by the American College of Obstetricians and Gynecologists. Bundles exist for obstetric hemorrhage, severe hypertension in pregnancy, perinatal mental health conditions, and care for pregnant and postpartum people with substance use disorder.
Those topics are not chosen at random. Hemorrhage and hypertensive disorders are among the leading causes of severe maternal morbidity that reviewers repeatedly classify as preventable. A bundle is essentially a checklist plus a drill: standard supplies staged in one place, a defined threshold for escalating care, and rehearsed team responses so that nobody is improvising at three in the morning.
Results from these programs have been documented at the state level. The National Network of Perinatal Quality Collaboratives reports work across all states, and the CDC has attributed reductions in low-risk cesarean births, early elective deliveries, newborn infections and severe pregnancy complications to collaborative efforts.
Naming the Collaborative Turns an Attestation into a Checkable Fact
The practical effect of the update is verification.
An unnamed yes cannot be cross-referenced against anything. A named collaborative can be checked against that collaborative's own participant roster, its published initiatives, and the bundles it is currently running. It also reveals which hospitals sit in states with well-established, long-running collaboratives and which are in states where the collaborative is newer or narrower in scope.
That said, the requirement has limits worth stating plainly. Naming a collaborative confirms membership. It does not measure how faithfully a hospital implements the bundles, how often staff drill them, or what its outcomes actually look like. A hospital can be a member in good standing and still perform inconsistently. This is a structural measure, which in quality-measurement terms means it captures capacity and participation rather than results.
CMS separately sought comment this year on updating the scoring behind the Birthing Friendly designation to reflect performance on measures such as cesarean birth rates, which would move the designation closer to outcomes. That remains under consideration rather than finalized.
Families Comparing Hospitals Before a Birth
For a household choosing where to deliver, the useful move is not to wait for FY 2028 data.
Anyone who wants to know now can ask the labor and delivery unit directly which perinatal quality collaborative the hospital participates in, and which safety bundles it has implemented. Hospitals running hemorrhage and hypertension bundles are generally willing to say so, and the answer usually comes quickly from a nurse manager or the unit's quality lead. ACOG maintains guidance on the measure and points hospitals toward their state collaboratives, and the CDC keeps a public list of collaboratives by state.
The people with the most at stake are those with risk factors for the conditions the bundles target: a history of postpartum hemorrhage, chronic or gestational hypertension, preeclampsia in a prior pregnancy, a bleeding disorder, or a planned repeat cesarean. Rural residents also face a narrower set of choices, since many rural obstetric units have closed and the nearest alternative may be an hour away.
None of this substitutes for a conversation with an obstetric clinician who knows the individual pregnancy. Hospital choice is one input among several, and it is rarely the deciding one for a person with an established care team.
The Timeline and Open Questions
The reporting change begins with the FY 2028 payment determination, so the first data reflecting named collaboratives will not appear publicly for some time. The rest of the FY 2027 rule takes effect at the start of the federal fiscal year.
Several questions remain open. CMS has not said whether it will publish the collaborative names in a searchable format or bury them in a data file. It has not finalized the Birthing Friendly scoring changes it solicited comment on. And there is no published analysis yet of whether requiring the name changes hospital behavior, because the requirement has not taken effect.
The confirmed fact is narrow: Medicare will require hospitals to name their perinatal quality collaborative starting with FY 2028. The people most affected are pregnant patients with risk factors who are choosing among hospitals. The most reasonable action available today is to ask the delivering hospital directly rather than wait for federal data. The central uncertainty is whether naming participation eventually connects to measurable differences in outcomes. MedicalDaily will monitor CMS quality reporting guidance and next spring's proposed rule.
Frequently Asked Questions
What exactly did CMS change?
Hospitals reporting the Maternal Morbidity Structural measure will have to identify which perinatal quality collaborative they participate in, rather than simply attesting that they participate in one. The change begins with the FY 2028 payment determination.
What is a perinatal quality collaborative?
A state or multistate network of hospitals, clinicians and public health partners that works to improve maternal and infant care by spreading specific evidence-informed practices and tracking whether they are followed.
What are patient safety bundles?
Standardized sets of practices for specific obstetric emergencies. Common bundles cover obstetric hemorrhage, severe hypertension in pregnancy, perinatal mental health conditions, and substance use disorder in pregnancy.
Does this mean some hospitals are unsafe?
No. The measure captures participation, not outcomes. A hospital that participates is not guaranteed to perform well, and one that does not participate is not automatically unsafe.
Can I find out which collaborative my hospital belongs to right now?
Yes. Ask the labor and delivery unit directly, or check your state's collaborative website. You do not need to wait for the federal reporting change.
Who should pay the most attention?
Pregnant patients with a history of hemorrhage, hypertensive disorders, preeclampsia or bleeding disorders, and people in areas where obstetric units have closed and choices are limited.
When will the data be public?
Not immediately. The requirement begins with the FY 2028 payment determination, and CMS has not announced how or where the collaborative names will be displayed.
