Birth center accreditation by the Commission for the Accreditation of Birth Centers (CABC) is an evaluation of a birth center's compliance with the CABC Indicators for Compliance, ending in a site visit of up to three days and a decision letter. This page is for freestanding birth center operators and hospitals creating alongside midwifery units (AMUs). Integral Healthcare Solutions (IHS) builds the birth center's policies and evidence file to the CABC standards; your midwives and physicians own every clinical protocol.
Last reviewed: October 2026.
What is CABC birth center accreditation?
CABC states: "Accreditation is a rigorous process evaluating a birth center's compliance with hundreds of specific Indicators or measures" (CABC, Accreditation Process). Freestanding birth centers are reviewed against the CABC Indicators for Compliance, and alongside midwifery units against a separate set of AMU Indicators. The current edition number was not shown on the pages we reviewed; the download is behind a form.
Beneath the Indicators sits a national standard. The CABC Accreditation Agreement states: "The CABC chooses to use the AABC National Standards for Birth Centers in CABC Accreditation" (CABC Accreditation Agreement v.2026.09). The AABC standards are published by the American Association of Birth Centers.
The process ends with a site visit. "The accreditation site visit is conducted over a three-day period, concluding with an Exit Conference to summarize preliminary findings and next steps." CABC's Milestones chart lists the Site Visit as 2-3 days, so confirm your visit length when you schedule. The visit covers "Chart Review Personnel File Review Staff and Stakeholder Interviews Facility Walkthrough Review of the Quality Assurance Program." CABC states that it "typically renders accreditation decisions 4-6 weeks after the site visit" (CABC, Accreditation Process).
State birth center licensing rules apply separately and vary by state. This page does not summarize any state's rules.
Who needs it and what triggers it
The buyer is a freestanding birth center operator, or a hospital creating an alongside midwifery unit. The work usually starts with one of these events:
- State licensure. CABC lists the states where its accreditation "is required for state licensure": Connecticut, Indiana, Illinois, Louisiana, Minnesota, Mississippi and Nevada. It lists Alaska, Arizona, Florida and Washington as states where CABC accreditation "has deeming authority," meaning "it is accepted in lieu of a state inspection" (CABC, Accreditation Process).
- Payer contracting. CABC states: "Many state Medicaid programs require CABC accreditation for facilities to qualify for contracts and reimbursement. Several private insurance payers also require CABC accreditation as a condition for facility contracting" (same page). Check the terms of each payer you contract with.
- Opening a new center or unit. CABC's Agreement says a new center or AMU "open less than one year or has had less than 100 births will be applying for a 1 year accreditation" and one "open more than 1 year or has had more than 100 births may apply for a 3 year accreditation" (CABC Accreditation Agreement). A center on different sides of the two tests, for example open 14 months with 60 births, fits both sentences, and the text does not say which controls. CABC's milestones list "Confirm Starting Point of 1-year or 3-year Accreditation" as a CABC step, so CABC makes the call (CABC, Milestones). IHS can draft the question to CABC with your dates and birth count; your center sends it.
- A decision letter with requirements. CABC's milestones call for a Progress Report within "90 days after receipt of Decision Letter" (CABC, Milestones for first-time accreditation).
How IHS helps
IHS works from the CABC Indicators your center receives from CABC. The process:
- Gap assessment. IHS reads the center's documents against the Indicators and writes down each gap with the Indicator it comes from.
- Questionnaires and evidence mapping. IHS sends questionnaires on governance, eligibility criteria, transfers and staffing, then builds a crosswalk from each Indicator to the evidence on CABC's Document Checklist.
- Drafting. IHS drafts governance, operating and quality policies and transfer agreement templates. Clinical protocols are drafted for your midwifery and obstetric leads to approve.
- Mock review. Before CABC's review of your documents, IHS reviews the evidence file against the Indicators as a reviewer would and lists what is missing or thin.
- Readiness support. After the Decision Letter, IHS drafts Progress Report responses for your center to submit.
What you supply: the Indicators, your current protocols, your transfer partners, staff credentials, and your midwives and physicians.
The limit: IHS does not bring midwifery or obstetric expertise. Your clinicians own every clinical protocol, and facility and site safety need your facilities staff. IHS describes its process here and does not claim prior CABC engagements. Your center registers with, submits to and corresponds with CABC; IHS drafts, and you submit.
What to have ready
Each item below ties to CABC's accreditation process page, the Accreditation Agreement v.2026.09 or CABC's milestones for first-time accreditation, read October 2026.
- Your copy of the CABC Indicators for Compliance, or the AMU Indicators if you are a hospital unit, and a list of which Indicators apply to you (CABC, Accreditation Process).
- Your state's position: whether CABC accreditation is "required for state licensure" or has "deeming authority" where you operate (same page), and your state's own licensing rules.
- Your contract terms with Medicaid and private payers, since CABC states that many Medicaid programs and several private payers require its accreditation (same page).
- Your opening date and birth count, which CABC uses to confirm whether you start at 1-year or 3-year accreditation (CABC Accreditation Agreement; CABC, Milestones). The Agreement's two thresholds can overlap, so confirm your starting point with CABC before budgeting; IHS drafts the question, your center sends it.
- A target site visit month 6 to 12 months out (CABC's process page says to engage "at least 6 months" before your desired site visit month), with the Initial Registration form, signed Accreditation Agreement and first half of the Initial Registration fee due 6-12 months before the visit (CABC, Milestones).
- The documents on CABC's Document Checklist, due "2-3 months before the Site Visit" (same document).
- Chart, personnel file and quality assurance records ready for review, since the site visit includes "Chart Review Personnel File Review Staff and Stakeholder Interviews Facility Walkthrough Review of the Quality Assurance Program" (CABC, Accreditation Process).
- Your transfer agreements and the clinical protocols your midwives and physicians have approved.
- A process for notifying CABC of "A sentinel event" "Within 14 days of the sentinel event," as the Agreement requires (CABC Accreditation Agreement).
The introductory call is the place to walk through this list against your own center.
How it compares
| Route | What it is | Basis |
|---|---|---|
| CABC accreditation, freestanding birth center | Review against the CABC Indicators for Compliance, which build on the AABC National Standards for Birth Centers; site visit of up to three days | CABC, Accreditation Process; CABC Agreement |
| CABC accreditation, alongside midwifery unit | CABC states that both freestanding birth centers and AMUs are eligible; AMUs are reviewed against separate AMU Indicators with a separate agreement | CABC, Accreditation Process |
| State licensure without CABC accreditation | Whether a state requires accreditation, and which accreditors it accepts, is set by each state's rules and was not reviewed. CABC lists seven states where its own accreditation is required for licensure; check your state's rules | CABC, Accreditation Process |
The table describes scope only. Which route fits depends on your state, your payers and your plans for the center.
What it costs
The cost has two parts you can see in advance: CABC's own fees, which CABC publishes in Addendum A of its Accreditation Agreement, and the cost of preparation, which depends on your gaps. CABC's fees, from Addendum A "Revised September 1, 2026" and read October 2, 2026, are below. These are CABC's fees, not IHS fees.
| CABC fee | Primary location | Each remote location | Each Local+1 location |
|---|---|---|---|
| Initial Registration | $6,000 | + $6,000 | + $3,000 |
| 1-Year Review (re-accrediting after 1-year accreditation) | $4,000 | + $4,000 | + $2,000 |
| Enrolled Birth Center subscription (3-year cycle) | $350/month | + $350/month | + $225/month |
Source: CABC Accreditation Agreement v.2026.09, Addendum A. For Initial Registration, the "First half of total is due in order to gain access to the Accreditation Training, Materials, Resource Center, Mentor Program," and the "Second half is due in order to schedule the site visit review." The Enrolled Birth Center subscription "includes future site visit expenses." Alongside midwifery unit fees are in a separate CABC agreement that we did not review. Verify current fees with CABC before budgeting.
IHS scopes each engagement after a free introductory call.
What this is not
- IHS is not CABC and does not grant, predict or influence an accreditation decision.
- IHS does not register with, submit to or correspond with CABC or a state agency for your center. Your center does.
- IHS does not write or judge clinical protocols, and this page is not legal advice on state licensure.
Frequently asked questions
What is CABC accreditation for birth centers, and what does it review?
CABC describes accreditation as "a rigorous process evaluating a birth center's compliance with hundreds of specific Indicators or measures" (CABC). The site visit covers chart review, personnel files, staff and stakeholder interviews, a facility walkthrough and the quality assurance program.
Is CABC accreditation required for birth center licensure in my state?
CABC lists Connecticut, Indiana, Illinois, Louisiana, Minnesota, Mississippi and Nevada as states where its accreditation is required for licensure, and Alaska, Arizona, Florida and Washington as states where it is "accepted in lieu of a state inspection" (CABC). For any other state, read that state's birth center licensing rules.
Do Medicaid and private insurers require birth center accreditation to contract?
CABC states that "Many state Medicaid programs require CABC accreditation for facilities to qualify for contracts and reimbursement" and that "Several private insurance payers also require CABC accreditation as a condition for facility contracting" (CABC). The requirement that applies to you is in each payer's own contract terms.
How long does it take to get a new birth center accredited by CABC?
CABC's milestones start "6-12 months before the Site Visit" with the Initial Registration form, the signed Agreement and the first half of the registration fee, and call for the Document Checklist documents "2-3 months before the Site Visit" (CABC, Milestones). CABC "typically renders accreditation decisions 4-6 weeks after the site visit" (CABC).
How much does CABC birth center accreditation cost in 2026?
CABC's Addendum A, revised September 1, 2026, lists Initial Registration at $6,000 for the primary location, $6,000 for each remote location and $3,000 for each Local+1 location. The Enrolled Birth Center subscription is $350 a month for the primary location and includes future site visit expenses (CABC Agreement). Verify current fees with CABC.
What is the difference between CABC 1-year and 3-year accreditation?
A center or AMU "open less than one year or has had less than 100 births will be applying for a 1 year accreditation." One "open more than 1 year or has had more than 100 births may apply for a 3 year accreditation" (CABC Agreement). The two sentences overlap for a center that is past one year but under 100 births, or the reverse, and neither covers exactly one year or exactly 100 births. CABC confirms each center's starting point, so ask CABC before you plan around either one. Re-accrediting after a 1-year accreditation carries its own 1-Year Review fee.
What happens during the CABC site visit?
CABC lists "Chart Review Personnel File Review Staff and Stakeholder Interviews Facility Walkthrough Review of the Quality Assurance Program." The visit concludes "with an Exit Conference to summarize preliminary findings and next steps" (CABC).
What documents does CABC require before the site visit?
CABC's milestones call for the center to "Submit the documents listed on the Document Checklist" 2 to 3 months before the site visit (CABC, Milestones). The checklist itself comes from CABC; IHS maps each Indicator to the checklist evidence.
What are the AABC Standards for Birth Centers, and how do they relate to the CABC Indicators?
They are the American Association of Birth Centers' national standards. CABC's Agreement states that "The CABC chooses to use the AABC National Standards for Birth Centers in CABC Accreditation" (CABC Agreement). The Indicators are the measures CABC reviews a center against.
What happens after the CABC decision letter?
Within "90 days after receipt of Decision Letter," the center completes a Progress Report "addressing requirements outlined in the Decision Letter" (CABC, Milestones). Enrolled centers receive "One site visit at the Birth Center every three years" and CABC review of "two Interim Status Reports" (CABC Agreement).