Xavier Becerra United States Secretary of Health and Human Services | Official Website
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has proposed new policies aimed at reducing maternal mortality and morbidity, particularly among underserved communities. The Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule includes measures to increase access to care and advance health equity.
Key proposals include exceptions to the Medicaid clinic services "four walls" requirement, codifying 12 months of continuous eligibility for children enrolled in Medicaid and CHIP as mandated by the Consolidated Appropriations Act, 2023 (CAA, 2023), and introducing an add-on payment to the All-Inclusive Rate (AIR) for certain Indian Health Services (IHS) and tribal facilities. Additionally, CMS aims to expand hospital outpatient, ASC, and rural emergency hospital quality program measure sets to include equity measures and support individuals transitioning from incarceration by eliminating barriers to enrolling in Medicare coverage.
Vice President Harris stated, "President Biden and I are fully committed to addressing a maternal health crisis in which women across America – disproportionately Black women, Native women, and women in rural communities – are dying before, during, and after childbirth at higher rates than in any other developed nation." She emphasized that these new policies would strengthen maternal health and improve access to high-quality care for millions of women and children nationwide.
HHS Secretary Xavier Becerra remarked on the urgency of addressing maternal health disparities: "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." He affirmed that HHS is taking steps to enhance maternal care quality at hospitals across the nation.
CMS Administrator Chiquita Brooks-LaSure highlighted that the proposed hospital outpatient rule builds on existing efforts by the Biden-Harris Administration to reduce maternal mortality rates. She noted that this proposal demonstrates a commitment to ensuring meaningful healthcare coverage.
CMS reviews payment rates and policies annually for OPPS and ASC systems. For CY 2025, CMS proposes updating OPPS payment rates by 2.6% for hospitals meeting applicable quality reporting requirements. This update is based on a projected hospital market basket percentage increase of 3%, reduced by a productivity adjustment of 0.4 percentage points. Similarly, ASC rates would also see a 2.6% increase under this proposal.
For the first time, CMS proposes baseline health and safety requirements for hospitals providing obstetrical services. These new standards include guidelines for organization, staffing, delivery of care within obstetrical units, emergency services readiness, transfer protocols for obstetrical patients, annual staff training on evidence-based practices in maternal health, and cultural competencies.
Dr. Dora Hughes of CMS emphasized the agency's commitment: "CMS is using all of our tools to improve the safety, quality, and timeliness of the care that hospitals provide to pregnant women."
The proposed rule also addresses barriers faced by formerly incarcerated individuals in accessing Medicare coverage immediately upon release. By narrowing the definition of "custody," CMS aims to remove obstacles preventing these individuals from obtaining necessary healthcare coverage.
Additionally, CMS proposes paying separately for six drugs and one device used as non-opioid treatments for pain relief in hospital outpatient departments and ASCs as part of its behavioral health goals outlined in CAA 2023.
To support IHS and tribal facilities further, CMS suggests allowing certain Medicaid-covered clinic services outside traditional clinic settings. This proposal includes exceptions from the four walls requirement for behavioral health clinics located in rural areas.
The Biden-Harris Administration continues its Cancer Moonshot initiative with this proposed rule by facilitating better access to cancer treatment at IHS and tribal facilities through additional AIR payments for high-cost drugs significantly exceeding current AIR levels.
Dr. Meena Seshamani of CMS summarized: "With this proposed rule we are helping make sure that all people can access care more equitably."
The CY 2025 OPPS/ASC Payment System proposed rule will be open for public comment until September 9th, 2024. The full text can be accessed via the Federal Register link provided below:
For further details on the CY 2025 OPPS/ASC Payment System proposed rule:
