Grand Canyon Times

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, which disproportionately affect underserved communities. The Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule also 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 included in the Consolidated Appropriations Act, 2023 (CAA, 2023), and an add-on payment to the All-Inclusive Rate (AIR) for certain Indian Health Services (IHS) and tribal facilities to increase access to high-cost drugs. Additionally, the hospital outpatient, ASC, and rural emergency hospital quality program measure sets will be expanded to include equity measures consistent with other provider types. The proposal also supports individuals returning from incarceration by eliminating barriers to enrolling in and maintaining Medicare coverage.

Vice President Harris emphasized the administration's commitment: “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. That is why I called on states to extend Medicaid postpartum coverage from two months to 12 months – with 46 states taking action – and why we launched the White House Blueprint for Addressing the Maternal Health Crisis.”

HHS Secretary Xavier Becerra added: “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. HHS is taking additional steps to improve maternal health by strengthening the care new moms and their babies receive at our nation’s hospitals.”

CMS Administrator Chiquita Brooks-LaSure noted: “The proposed hospital outpatient rule builds on the Biden-Harris Administration’s commitment to reducing the nation’s high maternal mortality rate... This proposed rule is proof that we are committed to ensure people aren’t just covered but that coverage is meaningful.”

The CMS proposes updating OPPS payment rates for CY 2025 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 0.4 percentage points for productivity adjustment. Similarly, ASC rates will be updated by 2.6% for ASCs meeting relevant quality reporting requirements.

For the first time, CMS proposes baseline health and safety requirements for hospitals and critical access hospitals (CAHs) offering obstetrical services. These include standards for organization, staffing, delivery of care within obstetrical units, emergency services readiness, transfer protocols for obstetrical patients, and annual staff training on evidence-based maternal health practices.

Dr. Dora Hughes stated: “CMS is using all of our tools to improve the safety, quality, and timeliness of the care that hospitals provide to pregnant women... leading to improved outcomes and better health.”

Further supporting underserved communities, CMS proposes narrowing the definition of “custody” to remove barriers ensuring people no longer incarcerated can access Medicare coverage immediately following release.

Additionally, CMS aims at behavioral health goals by proposing separate payments in hospital outpatient departments and ASCs for six drugs and one device used as non-opioid treatments for pain relief.

Responding to stakeholder concerns post-COVID-19 flexibilities, CMS proposes allowing certain Medicaid-covered clinic services outside clinics provided by IHS or tribal clinics.

Dr. Meena Seshamani commented: “With this proposed rule... The Medicare program is meant to work for everyone – including those transitioning from incarceration...”

The CY 2025 OPPS/ASC Payment System proposed rule has a comment period ending September 9, 2024.