WASHINGTON, D.C.— The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has unveiled new regulations designed to improve safety standards in maternity care and expand health care access across underserved populations. These regulations, encompassed within the calendar year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule, establish groundbreaking requirements for hospitals and Critical Access Hospitals (CAHs) that provide obstetrical services.
CMS Administrator Chiquita Brooks-LaSure articulated the agency’s commitment to addressing the nation’s maternity care challenges, stating that the newly established maternal health and safety standards for hospitals are unprecedented. These standards are set to raise the bar for the organization, staffing, and delivery of care within obstetrical units, requiring comprehensive staff training on evidence-based maternal health practices.
In a significant move to bolster health equity, the final rule also includes measures to dismantle barriers to care for individuals who were formerly incarcerated and other underserved groups. It amends the Medicare enrollment criteria to facilitate access for those on bail, parole, probation, home detention, or residing in halfway houses, thus bridging critical gaps during transitional phases from incarceration to community reintegration.
Key financial adjustments accompany these regulatory changes. The CY 2025 OPPS and ASC final rule updates payment rates for hospital outpatient and ASC services with a 2.9% increase, reflecting a 3.4% market basket adjustment, less a 0.5 percentage point reduction for multifactor productivity. This adjustment is projected to elevate OPPS payments by an additional $2.2 billion for CY 2025 compared to the previous year.
Addressing the pressing issue of opioid misuse, CMS is implementing policies to encourage the use of non-opioid alternatives in pain management. The rule finalizes additional payments for FDA-approved non-opioid drugs and medical devices proven to reduce opioid consumption, aligning with broader behavioral health and opioid reduction goals. Additionally, payments for Indian Health Services and tribal hospital outpatient departments will increase, supporting access to high-cost drugs crucial for cancer treatment and aligning with the Biden-Harris Administration’s Cancer Moonshot initiative.
Dr. Meena Seshamani, Deputy Administrator and Director of CMS’ Center for Medicare, emphasized that these policies are instrumental in tackling health disparities. They ensure that postoperative pain relief options reduce opioid exposure and that access to essential health services is expanded for marginalized groups.
Moreover, the rule significantly expands Medicaid’s reach, providing states the option to extend clinic services beyond the traditional boundaries of Indian Health Services and Tribal clinics, including behavioral health and rural clinics. It also codifies a 12-month continuous eligibility requirement for children on Medicaid and CHIP, promoting sustained access to care.
These comprehensive changes underscore CMS’s dedication to enhancing health care quality and accessibility, particularly for vulnerable and underserved communities. As these rules take effect, they mark a pivotal step in advancing equitable health care nationwide.
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