Navigating the New Obstetrical Services Conditions of Participation on Emergency Services and Transfer Protocols

This resource was created in partnership by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Emergency Physicians (ACEP)

In November 2024, the Centers for Medicare and Medicaid Services (CMS) finalized two changes to the Conditions of Participation (CoP) program: a new Obstetrical Services CoP, focused on obstetrical services, and changes to the existing Emergency Services CoP and Discharge Planning CoP.

As part of these changes, facilities with obstetrical units will need to meet several requirements in three major sections: organization, staff training, and quality assessment and performance improvement. For facilities with dedicated emergency units, new requirements have been introduced regarding emergency services readiness and transfer protocols. For facilities with both an obstetrical unit and an emergency unit, all of these requirements must be met.

The following information is on the set of requirements, Emergency Services Readiness and Transfer Protocols, that took effect on July 1, 2025.

What Are Conditions of Participation?

Conditions of Participation, or CoPs, are requirements developed by CMS that facilities need to meet in order to begin and continue participating in federally funded health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The requirements typically are health and safety guidelines intended to protect beneficiaries by improving quality care and enforcing patient rights.

Which Facilities Are Subject to These New Requirements?

These requirements apply to hospitals and Critical Access Hospitals (CAHs) receiving Medicare dollars. They do NOT apply to designated Rural Emergency Hospitals (REHs).

New Emergency Services Readiness Requirements

The Centers for Medicare and Medicaid Services is updating the existing Emergency Services CoP (42 CFR §482.55) to include the following requirements:

• Facilities must have adequate provisions and protocols to meet the emergency needs of patients in accordance with the complexity and scope of services offered.
• Applicable emergency services personnel would need to be trained on these protocols and provisions annually.

New Transfer Protocol Requirements

The Centers for Medicare and Medicaid Services is updating the existing Discharge Planning CoP (42 CFR §482.43) to include the following requirements on transfer protocols:

• Facilities must have written policies and procedures for transferring patients under their care.
• Facilities must provide training to the relevant staff regarding the hospital policies and procedures for transferring patients under its care.

Resources

• ACOG/SMFM Levels of Maternal Care
• Identifying and Managing Obstetric Emergencies in Nonobstetric Settings (ACOG)
• Emergency Obstetrics Resources (ACEP)