The Centers for Medicare & Medicaid Services (CMS) on July 10 released the calendar year (CY) 2025 Outpatient Prospective Payment System (OPPS) proposed rule. In the proposed rule, the CMS proposed to increase the payment rates by 2.6% for items and services paid under OPPS for 2025. Additionally, the CMS proposed new Conditions of Participation (CoPs) for hospitals and critical access hospitals for obstetrical services and revisions to the emergency services CoP and the discharge planning CoPs using input from two requests for information in the fiscal years 2023 and 2025 Inpatient Prospective Payment System (IPPS) proposed rules. Included in this proposal is a requirement for hospitals to have written policies and procedures for transferring patients under their care to the appropriate level of care as needed to meet the patients’ needs, including transfers from one unit to another within the same hospital.
Beyond this, the CMS addressed several issues within the proposed rule including the addition of three services to the Inpatient Only list, timeframes for the hospital outpatient department prior authorization process, intensive outpatient program and partial hospitalization program rate setting, remote services, access to non-opioid treatments for pain relief, payment for specialized diagnostic radiopharmaceuticals, add-on payments for domestically produced technetium-99m, changes to the definition of “custody” in Medicare's payment exclusion rule, changes to continuous eligibility for children in Medicaid and the Children’s Health Insurance Program (CHIP), changes to the Medicaid clinic services four walls exceptions, and the payment adjustments under the IPPS and OPPS for domestic personal protective equipment. Additionally, the agency seeks feedback on how to better emphasize patient safety in its Overall Hospital Quality Star Ratings.
Comments are due Sept. 9.
- Washington Highlights