Two deadlines in January tell the story of a proposed change for rural maternity care. Under a rule finalized in 2024, critical access hospitals that provide inpatient obstetric care are due to start meeting new training and quality requirements on January 1, 2027. A proposal published November 10 would drop those requirements, but its comment deadline is January 11, ten days after the scheduled start.
The two sets of requirements cover different work. Under the 2024 rule, hospitals would have to set policies to train relevant staff on maternal care, with topics tailored to the services they provide. They would also have to track outcomes and disparities among obstetric patients and run at least one measurable improvement project each year focused on maternal outcomes and disparities.
The November proposal would remove those obstetric-specific duties while leaving the broader hospital quality program in place. The Centers for Medicare & Medicaid Services says the staff time and administrative costs, on top of existing financial and workforce pressures, could affect whether some critical access hospitals keep providing obstetric care at their current level. That is a risk the agency identifies, rather than a finding that the January requirements have caused a maternity unit to close.
The proposal says CMS considers it unlikely that the repeal would be final by January 1. It says the agency would ask surveyors to focus on requirements that are less likely to change. That would be a direction about what inspectors prioritize; the proposal itself does not postpone the January 1 start. Comments on file CMS–3484–P must reach the agency by January 11 to be assured consideration.