The Centers for Medicare & Medicaid Services (CMS) on Wednesday released the 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. Here is an initial look at what’s included in the 984-page proposal.
In its continued effort to strengthen Medicare and advance key goals of the Biden-Harris administration, this year’s rule proposes policies that address health disparities, expand access to behavioral health care, improve transparency in the health system, and promote safe, effective, and patient-centered care.
The proposed rule, which will be published in the Federal Register on July 22, affects roughly 3,500 hospitals and 6,100 ASCs. Comments on the proposal are due to CMS by September 9.
Among the changes: CMS plans to introduce new policies that aim to reduce maternal mortality and morbidity, which disproportionally affect underserved communities, and increase access to care and advance health equity.
“For too long, too many women in the United States have been dying during pregnancy or in the postpartum period, and this crisis has disproportionately affected women of color,” said Department of Health and Human Services Secretary Xavier Becerra in the announcement. “HHS is taking additional steps to improve maternal health by strengthening the care new moms and their babies receive at our nation’s hospitals. The Biden-Harris Administration continues to be committed to making pregnancy and childbirth safer.”
In the proposed rule, CMS announced plans to:
- Update OPPS payment rates for CY 2025 for hospitals that meet applicable quality reporting requirements by 2.6 percent
- Update the ASC rates for CY 2025 by 2.6 percent for ASCs that meet relevant quality reporting requirements
- Establish baseline health and safety requirements for obstetrical services provided by hospitals and critical access hospitals, including staffing, delivery of care, emergency services readiness, transfer protocols for obstetrical patients, and annual staff training on evidence-based maternal health practices and cultural competencies
- Narrow the definition of “custody” to remove real or perceived barriers to ensure that people with Medicare who are no longer incarcerated or not otherwise in the physical custody of penal authorities can have access to Medicare coverage for care
- Revise the eligibility criteria for the special enrollment period for formerly incarcerated individuals to include individuals who have been released from incarceration or who are on parole, probation, or home detention
- Implement access to non-opinion treatments for pain relief
- Support Indian Health Service and tribal facilities by allowing certain Medicaid-covered clinic services to be provided outside the clinic by requiring states to provide an exception to the four walls requirement for Medicaid clinic services provided by IHS and tribal clinics; increase access to cancer services that use high-cost drugs; pay an add-on to the All-Inclusive Rate (AIR) for high-cost drugs and biologics that significantly exceed AIR; and establish a pathway for Tribal facilities seeking to expand the breadth of health care services, including oncology, that they provide to their communities
“With this proposed rule, we are helping make sure that all people can access care more equitably,” said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, in the announcement. “The Medicare program is meant to work for everyone–including those transitioning from incarceration and those accessing care at IHS and tribal hospitals and the policies in this proposed rule represent a significant step forward in doing just that.”