On Nov. 27, CMS finalized rule to revise 2025 OPPS, ASC payments.
CMS revised the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for year 2025.
Amendments
Updates amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system.
Amends requirements for Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting, Ambulatory Surgical Center Quality Reporting Program.
Summarizes information received in response to RFI on potential modifications to the Safety of Care measure group in the Overall Hospital Quality Star Rating methodology.
Finalizes proposal to narrow description of custody in Medicare payment exclusion rule and to revise special enrollment period criteria for formerly incarcerated individuals.
Further, finalizes Medicaid and Children's Health Insurance Program (CHIP) eligibility.
Also finalizes proposal to reduce review timeframe for standard prior authorization requests for certain covered outpatient department services paid under the OPPS.
Rule finalizes updates to the Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) in an effort to advance health and safety of pregnant women.
This rule also finalizes policy to separately pay Indian Health Service (IHS) and Tribal hospitals for high-cost drugs in hospital outpatient departments with add-on payment.
Finally, finalizes exceptions to Medicaid clinic services four walls requirement for IHS and Tribal clinics, and, at state option, for behavioral health clinics and rural clinics.
