The Centers for Medicare and Medicaid Services issued a statement on November 1 final rule that increases Medicare hospital outpatient prospective payment system rates by a net 2.9% in calendar year 2025 compared to 2024. This includes a 3.4% market basket update, offset for a cut of 0.5 percentage points for productivity.

in a statement Speaking to the media, AHA Senior Vice President Ashley Thompson said, “Sustained and substantial underpayment of hospitals by Medicare has gone on for nearly two decades, and today’s outpatient final rule only This chronic problem worsens. The agency’s final increase of less than 3% for outpatient hospital services will make delivery of care, investments in the healthcare workforce and addressing new challenges, such as cybersecurity threats, more difficult. These inadequate payments will have a negative impact on patients’ access to care, especially in rural and underserved communities across the country.

The AHA fully shares CMS’s goals of improving maternal health outcomes and reducing disparities in maternal care. While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS’s overuse of the Conditions of Participation to push its political agenda and the potential risk that these requirements inadvertently reduce access to maternal care. We believe that a less punitive and more collaborative approach would be more effective given that the key drivers of maternal health outcomes are very complex and involve multiple stakeholders. “AHA remains committed to working with the Administration and other stakeholders to advance a full range of solutions to improve maternal outcomes.”

Additionally, CMS finalized its proposals to adopt three health equity-related measures for quality reporting programs for outpatients, ambulatory surgical centers, and rural emergency hospitals and to extend voluntary data reporting for two hybrid measures in the Program. quality reporting for inpatients.

The rule also finalizes several changes in the payment of medications. These include providing separate payments for diagnostic radiopharmaceuticals with daily costs above a threshold of $630, excluding from the package certain qualified cell and gene therapies under the comprehensive outpatient payment classification policy, and paying for HIV pre-exposure prophylaxis medications and services. related in the hospital. outpatient departments.

CMS also finalized new and updated Medicare Conditions of Participation for hospitals and critical access hospitals, including new standards focused on obstetric services and maternal health care. Beginning in January 2026, CMS will phase in certain requirements for hospitals and CAHs that offer maternal health services, including standards for the availability of certain obstetric equipment and staff training. In addition to maternal care requirements, CMS finalized a discharge planning standard for transfer protocols and established new emergency services requirements for certain types of equipment and supplies and staff training. Discharge planning and emergency services requirements will also be phased in from July 2025.

The final rule will go into effect on January 1. AHA members will receive a special newsletter on November 4 with more details.