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Maternal Mortality Focus of New HHS and CMS Proposed Policies for 2025

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Maternal mortality and morbidity, which disproportionately affect underserved communities, are the focus of new policies proposed by the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS). These policies are outlined in the Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. In addition to maternal health, the proposed rule seeks to increase access to care and advance health equity.

The Biden-Harris Administration, through these proposals, aims to address a maternal health crisis in the United States where women, particularly Black, Native, and rural women, experience higher rates of mortality before, during, and after childbirth compared to other developed nations. Vice President Kamala Harris highlighted the administration’s commitment to extending Medicaid postpartum coverage from two months to 12 months, with 46 states taking action. The administration has also launched the White House Blueprint for Addressing the Maternal Health Crisis, a comprehensive strategy to improve maternal care across the country.

Key measures in the proposed rule include exceptions to the Medicaid clinic services “four walls” requirement, codifying 12 months of continuous eligibility for children enrolled in Medicaid and CHIP, and proposing an add-on payment to the All-Inclusive Rate (AIR) for certain Indian Health Services (IHS) and tribal facilities to enhance access to high-cost drugs. The rule also aims to expand hospital outpatient, ASC, and rural emergency hospital quality program measure sets to include equity measures, and to support individuals transitioning from incarceration by eliminating barriers to Medicare coverage enrollment and maintenance.

CMS Proposes 2025 Rule to Reduce Maternal Mortality and Improve Care Access

CMS Administrator Chiquita Brooks-LaSure emphasized that the proposed rule builds on the administration’s commitment to reducing maternal mortality and improving access to care in underserved communities. She stressed that ensuring meaningful coverage for people is a priority, as reflected in the proposed policies.

Each year, CMS reviews and updates payment rates and policies for the OPPS and ASC payment systems. For CY 2025, CMS proposes to update OPPS payment rates for hospitals meeting applicable quality reporting requirements by 2.6%. This update is based on a projected hospital market basket percentage increase of 3%, reduced by 0.4 percentage points for the productivity adjustment. Similarly, ASC rates for CY 2025 would be updated by 2.6% for ASCs meeting relevant quality reporting requirements.

For the first time, CMS proposes baseline health and safety requirements for hospitals and critical access hospitals (CAHs) providing obstetrical services. Informed by stakeholder input, these requirements include standards for organization, staffing, care delivery within obstetrical units, emergency services readiness, transfer protocols for obstetrical patients, and annual staff training on evidence-based maternal health practices and cultural competencies.

Maternal Mortality

CMS Proposes New Rule to Enhance Maternal Care and Expand Medicare Access

Acting CMS Chief Medical Officer Dr. Dora Hughes highlighted the comprehensive approach being taken to improve the safety, quality, and timeliness of care for pregnant women. Through these proposals, CMS aims to ensure timely access to quality care in communities, leading to better health outcomes.

Building on the Biden-Harris Administration’s commitment to support underserved communities, the proposed rule also addresses barriers faced by formerly incarcerated individuals in enrolling in and maintaining Medicare coverage. The rule proposes narrowing the definition of “custody” to ensure that individuals who are no longer incarcerated or not in the physical custody of penal authorities can access Medicare coverage. Additionally, CMS proposes revising eligibility criteria for the special enrollment period for formerly incarcerated individuals to include those released from incarceration or on parole, probation, or home detention.

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The proposed rule supports CMS’s behavioral health goals by reducing opioid overdoses and ensuring effective pain management. It implements the provision of the CAA, 2023, by proposing separate payments in hospital outpatient departments and ASCs for non-opioid treatments for pain relief.

CMS Proposes Expanded Medicaid Services and Increased Access to Cancer Treatments

Responding to stakeholder concerns and building on COVID-19 flexibilities, CMS is also proposing to allow certain Medicaid-covered clinic services to be provided outside the clinic. This includes an exception to the four walls requirement for Medicaid clinic services provided by IHS and tribal clinics. States would have the option to create similar exceptions for behavioral health clinics and rural area clinics, advancing the HHS Roadmap for Behavioral Health and CMS Behavioral Health Strategy.

To increase access to cancer services and other high-cost drug therapies in IHS and tribal hospital outpatient departments, CMS proposes an add-on payment to the AIR for drugs and biologics significantly exceeding the AIR cost. This proposal supports the Biden Administration’s Cancer Moonshot initiative, which aims to prevent over 4 million cancer deaths by 2047 and improve the experience of individuals affected by cancer.

Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare, emphasized the goal of making Medicare work equitably for everyone, including those transitioning from incarceration and those accessing care at IHS and tribal hospitals. The proposed policies represent a significant step forward in achieving this goal.


Resource: Health and Human Services, July 10, 2024

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