2025 CMS Proposed Rule: Announcing this week a proposed rule for inpatient and long-term care hospitals (LTCHs) for the fiscal year of 2025 (FY), federal officials cited an increasing focus on social determinants of health (SDoH).
The Centers for Medicare & Medicaid Services (CMS) also prioritized improving maternal health and strengthening emergency preparedness, which noted that it is committed to supporting historically underserved communities and under-resourced communities while promoting value-based health care.
“Hospitals should be places where you can get the care you need, regardless of whether you have trouble paying your rent, the color of your skin, or what other problems exist in the world around you,” said Secretary of Health and Human Services (HHS). According to the Biden-Harris Administration, all efforts are being made to ensure hospitals have the prescription drugs and supplies they require in order to focus on what they do best – helping our loved ones stay healthy.
In a press release regarding the 2025 CMS Proposed Rule, it was stated that a 2.6 percent increase has been proposed for certain acute-care hospitals in operating payment rates. This is applicable to facilities receiving CMS payments under the Inpatient Prospective Payment System (IPPS), successfully participating in the Hospital Inpatient Quality Reporting Program, and using electronic health records in a meaningful manner. CMS anticipates a general increase of $3.2 billion in hospital payments as a result of the proposed increases in operating and capital IPPS payment rates.
For LTCHs, the increase would be 2.8 percent.
The CMS Administrator stated that the agency proposes changes that will lead to a more equitable and resilient health care system. “Our proposals regarding payment and quality focus on rewarding hospitals that achieve better outcomes, as well as supporting hospitals’ efforts to reach underserved communities. Additionally, we seek public comment on additional efforts to improve access to quality care during pregnancy, childbirth, and the postpartum period.”
It was noted by officials that the SDoH’s emphasis includes additional measures that are intended to increase payments and support for hospitals that provide services for individuals experiencing homelessness, sickle cell disease, maternal complications, and behavioral health issues, along with the addition of new data elements and additional payments. As it pertains to behavioral health services, the rule implements section 4122 of the Consolidated Appropriations Act of 2023, which requires that at least half of the 200 new graduate medical education slots available in 2026 be devoted to psychiatry or psychiatry subspecialties.
CMS is proposing an additional reporting structure based on lessons learned from the COVID-19 pandemic, including additional reporting that may be activated in the event of an emergency based on lessons learned from the COVID-19 pandemic. The 2025 CMS Proposed Rule also introduces a new attestation-based measure designed to assess whether hospitals adhere to a culture, structure, and leadership commitment that is committed to patient safety.
According to the CMS Deputy Administrator and Director of the Center for Medicare, hospitals play a crucial role in the diversity of the communities they serve. By providing hospitals with these payments, we acknowledge the cost of unmet social needs, increase access to innovative and essential treatments, expand the behavioral health workforce, and ultimately help provide them with the tools to better serve their communities.
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