News: OPPS final rule payment rates, maternal care inadequate, AHA says

CMS has issued a final rule pertaining to hospital Outpatient Prospective Payment System rates for the calendar year (CY) 2025, according to a federal press release.

The CY 2025 update, in comparison with CY 2024, includes a net increase of 2.9% for hospitals meeting applicable quality reporting requirements. According to CMS, this update is “based on the projected hospital market basket percentage increase of 3.4% reduced by a 0.5 percentage point productivity adjustment.”

The final rule is calculated to affect approximately 3,500 hospitals and 6,100 ambulatory surgical centers. According to CMS, the final rule also contains updates to the intensive outpatient program rate setting, the partial hospitalization program rate setting, as well as new regulations on access to non-opioid treatments for pain relief, and high drugs delivered in indigenous hospitals (among others).

While CMS has touted the new rule as an indication of the Biden administration’s commitment to outpatient services, the American Hospital Association (AHA) has voiced a different point of view.

“Medicare's sustained and substantial underpayment of hospitals has stretched for almost two decades, and today's final outpatient rule only worsens this chronic problem. The agency's final increase of less than 3% for outpatient hospital services will make the provision of care, investments in the health care workforce, and addressing new challenges, such as cybersecurity threats, more difficult,” said Ashley Thompson, senior vice president of the AHA in a press statement.

In its final rule, CMS also updated Medicare’s conditions of participation for hospitals and critical access hospitals, including updates pertaining to maternal health services. These updates, poised to begin in January 2026, also received substantial critique from the AHA.

 “[W]e 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 Thompson. “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 final rule goes into effect on January 1.

Editor’s note: To read the CMS fact sheet, click here. To read the AHA statement, click here. To read the CMS final rule, click here.