to main content Improve Maternal Outcomes at Your Health Care Facility | The Joint Commission


  • A new report from the National Center for Health Statistics, found that the number of maternal deaths rose 14 percent, to 861 in 2020 from 754 in 2019.
  • The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.

Look at data from recent years relating to maternal health in the U.S. and you’ll find a common thread — maternal mortality and morbidity are on the rise.

It’s a complex problem that will require a multifactorial approach.

In January 2022, Maternal Levels of Care Verification became available as a way to improve maternal patient outcomes.

Collaborating with the American College of Obstetricians and Gynecologists (ACOG), Joint Commission offers a program to facilities that provide obstetric and maternal-fetal medicine (MFM) care.

The program was developed using ACOG’s Levels of Maternal Care Obstetric Care Consensus (OCC), which includes comprehensive uniform definitions, a standardized description of maternity facility capabilities and personnel, and a framework for integrated systems that address maternal health needs.

A webinar focused on Maternal Levels of Care Verification covered how the program aims to reduce maternal morbidity and mortality by encouraging the evolution of systems to help standardize perinatal regionalization and risk-appropriate maternal care.

Featured presenters included:

  • Dr. Christopher Zahn, Vice President Practice Activities, ACOG
  • Jennifer Anderson, Department of Standards and Survey Methods, The Joint Commission
  • Lindsay Parker, Associate Director of Hospital Certification, The Joint Commission.
“Really, the gist of this program is to improve [maternal] outcomes, and it's important because it's less safe to have a baby today than it was for our mothers,” Jennifer notes in the webinar.

Different from accreditation and certification, Maternal Levels of Care Verification is an assessment of an organization’s resources, people and equipment. Its goal is to verify the organization can provide the level of care needed for the complexity of its patients.

Summarized remarks from the webinar describe the structure of the program as well as what to expect from an assessment. FAQs are covered as well.

A Brief Explanation: The Maternal Levels of Care

In his presentation, Dr. Zahn outlined the origin and background of the Maternal Levels of Care verification program, noting, “Risk-appropriate care is the key message.”

“It’s making sure that the facility has the resources to care for the at-risk patient, realizing that as risk elevates, so does the need for additional resources,” he explains. “In addition, it encourages collaborative relationships [to be] developed in regions, such that if services need to be escalated, there is a seamless process for consultation or transfer.”

Level I: Basic Care – Care for low to moderate-risk pregnancies, demonstrating the ability to detect, stabilize, and initiate management of unanticipated maternal-fetal or neonatal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a facility at which the specialty maternal care is available

Level II: Specialty Care – Level I, plus moderate- to high-risk antepartum, intrapartum, and postpartum conditions

Level III: Subspecialty Care – Levels I and II, plus care for more complex maternal medical conditions, obstetric complications, and fetal conditions

Level IV: Regional Perinatal Health Care Centers – Levels I, II, III, plus on-site medical and surgical care of the most complex maternal conditions and critically ill pregnant women and fetuses throughout antepartum, intrapartum, and postpartum care

“We recognize the majority of deliveries in this country are, in fact, performed at Level I and II facilities,” Dr. Zahn says. “The goal of Levels of Care is not to transfer everybody to Levels III and IV. It's to keep patients home with their family, with their support system as much as possible,” he adds.

Overview: Maternal Levels of Care Verification Review Process

To get the ball rolling with the Maternal Levels of Care Verification process, start early.

“As far as your timeline, we ask that organizations submit your online application about four to six months before you would like your onsite review to occur,” Lindsay notes. “We will also make sure that you have access to the review process guide. … that will help guide you through the day of the review,” she says.

Depending on the level of your organization, the review could take up to two days with a maximum of two reviewers for Level III and Level IV facilities. All reviewers are obstetric providers, such as OB nurses, midwives or clinicians.

A typical review will include the following:

  • Opening conference in which the reviewer introduces themselves and the process
  • HR session to check backgrounds and training of facility’s care providers
  • Medical credentialing
  • Discussion with staff about resources and processes
  • Assessment of charts to evaluate risk throughout a patient’s stay

Once completed, the review is valid for three years with no intracycle monitoring.

Once the on-site review has been completed, a preliminary report is submitted to the central office for further review. A final report is issued after that and might identify opportunities for improvement.

Once the final report is issued, facilities have 60 days to submit an evidence of standards compliance summary (ESC). Once submitted, the central office will review the ESC and determine whether the facility has met all opportunities for improvement.

Maternal Levels of Care Verification FAQ

Instead of submitting data on performance measures found in accreditation and certification, Maternal Levels of Care requires a detailed process improvement plan.

Maternal Levels of Care is a third-party review, streamlined to put the focus on risk-appropriate care for moms. This differs from the CDC’s LOCATe Tool, which is intended as a self-assessment tool.

The Maternal Levels of Care Manual has five very direct chapters:

  • Participation requirements: You do not have to be accredited by The Joint Commission to participate, but your hospital must be Medicare and Medicaid compliant and perform deliveries.
  • Information management: This details how a patient’s information will travel with them in the event of a transfer.
  • Delivering/facilitating care: Use evidence-based guidelines to identify risk throughout the patient’s stay, while ensuring that the patient is at the appropriate level of care, coordinating a transfer if needed.
  • Performance improvement: Measures to monitor would be maternal morbidity, mortality, and any other factor that feels important to your organization.
  • Program management: Knowing your own capabilities and having relationships with hospitals of other levels allows ease of exchange-whether that’s of knowledge or in creating seamless transfers for moms.

Contact information is listed below for how to get your copy of the manual.

One benefit of this verification is that it encourages telehealth communication between the lower levels and Level III and IV facilities — meaning once hospitals with more resources are identified, it will be easier to connect to the care your patient needs, even if a transfer isn’t the best route for them.

Ready to get started? Email to get connected with your Associate Director and get access to the manual for the program. Applications are available now.