CMS: Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program, etc.

Federal Register

Nov 27, 2024

Notice of final rule with comment period from the Centers for Medicare & Medicaid Services (CMS) revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2025. This rule also updates the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, Rural Emergency Hospital Quality Reporting (REHQR) Program, Ambulatory Surgical Center Quality Reporting (ASCQR) Program, and Hospital Inpatient Quality Reporting Program and finalizes updates to the Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services. Among other things, this rule summarizes comments received in response to an information request on potential modifications to the Safety of Care measure group in the Overall Hospital Quality Star Rating methodology. This rule also finalizes exceptions to the Medicaid clinic services benefit four walls requirement for Indian Health Service and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas. The provisions of this rule are effective January 1, 2025. Comments are due by December 31, 2024.

American Indian or Alaska Native · Behavioral health · Clinics · Healthcare quality · Hospitals · Inpatient care · Legislation and regulations · Maternal health and prenatal care · Medicaid · Medicare · Outpatient care · Reimbursement and payment models