New policies to reduce maternal mortality, increase access to care, and advance health equity
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new baseline health and safety requirements for hospitals and Critical Access Hospitals (CAHs) providing obstetrical (OB) services to make pregnancy, childbirth, and postpartum care safer.
CMS is also removing barriers to expand access to care for those formerly incarcerated and others in underserved communities. These policies are included in the calendar year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule, which also updates payment rates for hospital outpatient and ASC services for CY 2025 by 2.9% (3.4% market basket, less 0.5 percentage points for multifactor productivity). These payment updates are estimated to result in an additional $2.2 billion in CY 2025 OPPS payments for hospitals compared to CY 2024.
CMS has finalized new health and safety requirements for hospitals and CAHs providing obstetrical services, which set baseline standards for the organization, staffing, and delivery of care within obstetrical units, update the quality assessment and performance improvement (QAPI) program, and require staff training on evidence-based maternal health practices.
Additionally, the CY 2025 OPPS and ASC final rule implements policies to reduce the use of opioids and to increase access to high-cost drugs in tribal communities. CMS is finalizing the implementation of a provision from the Consolidated Appropriations Act, 2023 (CAA, 2023).
Medicare will make an additional payment for Indian Health Services (IHS) and tribal hospital outpatient departments to increase access to high-cost drugs, such as those involved in treating cancer.
The final rule is removing barriers to ensure that people with Medicare who are on bail, parole, probation, home detention, or who are required to live in halfway houses, can access Medicare services. CMS is also expanding the eligibility criteria for a special enrollment period for formerly incarcerated individuals to include individuals who have been released from incarceration or who are on bail, parole, probation, home detention, or live in halfway houses, to further support these individuals.
The rule will expand the clinic services’ benefit for services provided outside the “four walls” of IHS and Tribal clinics, and also gives states the option to cover Medicaid clinic services outside the “four walls” of behavioral health clinics and clinics located in rural areas. The final rule also codifies the requirement of 12 months of continuous eligibility for children enrolled in Medicaid and CHIP, which was enacted as part of the CAA, 2023.
