CMS proposes CARE rule (CMS-3484-P) to remove hospital and CAH obstetric training and OB QAPI requirements set for January 2027, adopt 2024 Life Safety Code, and drop exterior-window rule
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Medium priority
On November 5, 2026, CMS issued the Cutting Administrative Requirements for Excellence in Patient Care (CARE) proposed rule, which would revise Conditions of Participation after a review of the CoPs for all 21 provider and supplier types. For hospitals and critical access hospitals (CAHs) it would remove staff training requirements for emergency services readiness (and, for hospitals, transfer protocols) and for obstetric care, and remove the OB-specific Quality Assessment and Performance Improvement (QAPI) requirements that are otherwise effective January 1, 2027. It would adopt the 2024 National Fire Protection Association (NFPA) Life Safety Code and Health Care Facilities Code. CMS estimates $320 million in savings.
Background
In November 2024, in a final rule on the hospital outpatient and ambulatory surgical center payment systems for calendar year 2025, CMS finalized new Conditions of Participation for hospitals that offer obstetrical services. That rule added quality assessment and performance improvement requirements for hospitals that offer obstetric services and baseline standards for obstetric care, including staff training on evidence-based maternal health practices.
Who this affects
Hospitals, CAHs, rural emergency hospitals, long-term care facilities, intermediate care facilities for individuals with intellectual disabilities, hospice inpatient facilities and other providers subject to CoPs; state Medicaid agencies.
Why it matters
Inference: this is a proposal, so the obstetric CoP requirements otherwise effective January 1, 2027 remain on schedule unless CMS finalizes the removal; hospitals preparing OB training and QAPI programs should keep preparing while tracking the rule. Inference: facilities would need a Life Safety Code gap review against the 2024 edition if the rule is finalized.
Recommended action
- Decide whether to comment; comments received within 60 days after Federal Register publication (scheduled for 2026-11-10) are assured consideration.
- Keep January 1, 2027 OB CoP readiness work on track until a final rule says otherwise.
- Facilities and engineering: begin a gap review of the 2024 NFPA 101 and 99 editions.
Scope and timing
- Authority status
- Proposed
- Responsible owner
- Regulatory Compliance; Nursing/Women's services; Facilities
- Other dates
- Placed on public inspection 2026-11-05; scheduled Federal Register publication 2026-11-10 (after this edition's coverage week); CMS fact sheet dated 2026-11-05; comments assured consideration if received within 60 days after Federal Register publication (date bracketed in the public-inspection copy; calendar date not stated in that copy)
Not established
The calendar date for assured consideration of comments is not stated in the public-inspection copy (Federal Register publication scheduled for 2026-11-10, after this edition's coverage week). The CAH distance-exemption and the certified registered nurse anesthetist (CRNA) comment solicitation were not reviewed for this entry.
Sources
Complete edition and supplemental material
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