CMS highlights maternal care in CY 2025 OPPS, ASC final rule

CMS announced its final CY 2025 OPPS and ASC payment rule, which includes policies aimed at safeguarding maternal care and removing barriers to care for underserved communities. The final rule will also increase Medicare hospital outpatient facility and ambulatory surgical center payment rates by 2.9% in 2025 for entities that meet applicable quality reporting requirements.

The payment updates in the CY 2025 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system final rule were based on the projected hospital market basket percentage increase of 3.4% reduced by a 0.5 percentage-point productivity adjustment, CMS stated.

These payment updates will affect approximately 6,100 ASCs and 3,500 hospitals. They are expected to yield an additional $2.2 billion in 2025 OPPS payments for hospitals compared to 2024.

In addition to the payment rate adjustments, the rule includes policies that address maternal care and behavioral health disparities.

"CMS is committed to addressing our nation's maternity care crisis. Today, we are establishing the first-ever maternal health and safety standards for hospitals," CMS Administrator Chiquita Brooks-LaSure said in a press release.

"Additionally, the CY 2025 hospital Outpatient Prospective Payment System final rule expands access to behavioral health services, increases access to certain high-cost drugs for those facing cancer in tribal communities, and addresses barriers to Medicare coverage for those formerly incarcerated."

Specifically, the rule includes health and safety requirements for hospitals and critical access hospitals providing obstetrical services. The requirements, known as conditions of participation, include baseline standards for the organization, staffing and delivery of obstetrical care, as well as new requirements for maternal quality assessment and performance improvement. The updated requirements bolster CMS' maternity care action plan.

In response to the final rule, the American Hospital Association (AHA) expressed its shared goal of improving maternal health outcomes but took issue with CMS' use of conditions of participation in this space.

"While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS' excessive use of Conditions of Participation to drive its policy agenda and the potential risk for these requirements to inadvertently reduce access to maternal care," said Ashley Thompson, AHA senior vice president of public policy analysis and development, in a statement shared with the media.

"We believe a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are highly complex and involve multiple stakeholders. The AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes."

Thompson also shared the AHA's stance on the payment system rates, stating that the final rule and Medicare's "sustained and substantial underpayment of hospitals" will worsen patient access to care and make the provision of care more challenging to providers.

Aside from the maternal care provisions and the payment updates, the rule also contains policies aimed at reducing the use of opioids and increasing access to high-cost drugs in tribal communities and removing barriers to Medicare services for individuals who are on bail, parole, probation or home detention.

The final rule will go into effect on Jan. 1, 2025.

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.