CMS proposes 2.6% hospital outpatient pay increase

Hospital outpatient departments and ambulatory surgical centers would receive 2.6% reimbursement hikes next year under a proposed rule the Centers for Medicare and Medicaid Services issued Wednesday.

The draft regulation also includes a slew of maternal health and health equity provisions hospitals that participate in Medicare would be required to follow to receive the full pay hike, including policies on treatment and transfer protocols for pregnant patients.

The proposed hospital reimbursement update reflects a projected 3% hospital market basket increase offset by a -0.4% productivity adjustment.

CMS also would create a two-track per diem system for the Partial Hospitalization Program, along with the Intensive Outpatient Program established by the final rule for 2024.

Under each program, CMS would maintain two ambulatory payment classifications for each provider type: One for days with three services and another for days with at least four services. The methodology for both will remain the same, and CMS will calculate rates based on 2023 claims data and the latest cost reports, according to a news release.

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CMS also aims to implement several new health equity measures for hospitals, rural emergency hospitals and ambulatory surgical centers. Hospital outpatient departments and ambulatory surgical centers that don’t meet these standards, which include screening measures for social determinants of health and health equity, would receive a 2% reduction in their annual payment updates.

The draft regulation also would revise emergency services conditions of participation for obstetrics, gynecology and emergency transfers as part of the White House's maternal health agenda.

“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,” Health and Human Services Secretary Xavier Becerra said in a news release.

The proposed rule would impose additional maternal health quality assessment and improvement requirements, set standards for how obstetrics units are set up and staffed and how employees are trained. The agency also would mandate hospital emergency departments maintain stores of equipment, supplies and drugs.

CMS also aims to revise the Medicare special enrollment period eligibility criteria for formerly incarcerated people to include those who have been released or are on parole, probation or home detention.

The Ambulatory Surgical Center Association criticized the agency's decision not to include 18 cardiac and spinal procedure codes it recommended.

"Medicare beneficiaries would have more access to the care they need if the agency simply relied on the clinical expertise of surgeons who safely perform these procedures and who are best positioned to know where they can be performed,” Ambulatory Surgical Center Association CEO Bill Prentice said in a news release.

CMS will accept comments on the proposed rule for 2025 through Sept. 9. The final rule is expected in November.