CMS Proposes Updates to Medicare Payments and Policies, Including Focus on SDoH and Access to Maternal Care

CMS recently issued a proposed rule updating Medicare payments and policies for inpatient hospitals and long-term care hospitals.

The proposed rule for the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) introduces strategies to improve the well-being of Medicare beneficiaries, including efforts to tackle social determinants of health, create more robust emergency readiness and enhance maternal healthcare, according to a U.S. Department of Health and Human Services (HHS) news release.

In the proposed updates for fiscal year 2025, certain acute care hospitals are expected to experience a 2.6% increase in operating payment rates.

This adjustment is targeted toward acute care facilities meeting specific criteria: they must receive CMS payments under the IPPS, actively participate in the Hospital Inpatient Quality Reporting program and demonstrate meaningful use of electronic health records.

According to the release, CMS expects the proposed increase in operating and capital IPPS payment rates, in addition to other changes, could increase hospital payments by $3.2 billion.

As for LTCHs, CMS proposes to increase the LTCH PPS standard federal payment rate by 2.8%. They also expect LTCH payments to increase by 1.6%, or $41 million, mainly due to the proposed rate update.

In addition, improvements to the proposed 2025 IPPS rule aim to enhance services for the homeless.

In the 2024 IPPS final rule, CMS increased payments to hospitals for caring for homeless individuals.

The 2025 rule proposes further measures to address housing insecurity, which includes incorporating new social determinants of health data into LTCH quality reporting, such as housing stability, food security and transportation access, to better understand resource needs for care.

CMS is also advocating access to treatments to aid rural and underserved communities.

Means of improving access include proposed increased technology payments that could open the doors to gene therapy for sickle cell disease, which disproportionately affects underserved groups.

CMS also suggests separate payments to small independent hospitals, including rural ones, for ensuring access to essential medications.

“Hospitals play such a central role in the diverse communities they serve,” said Meena Seshamani, MD, PhD, CMS deputy administrator and director of the Center for Medicare, in the release. “Our proposed payments to hospitals further recognize the cost of unmet social needs, advance access to innovative and essential treatments, expand the behavioral health workforce, and ultimately help provide hospitals the vital tools they need to better serve all communities.”

As part of ongoing efforts to improve access to quality care throughout pregnancy, childbirth and postpartum, CMS is soliciting public feedback on potential solutions within hospital Conditions of Participation (CoPs).

These solutions could potentially tackle issues related to maternal morbidity, mortality, disparities and maternity care accessibility in the U.S.

The release noted that poor maternal health access has more of an effect on women of non-Hispanic Black descent, American Indian and Alaska Native women, low-income women and those with disabilities.

It was also noted that in 2021, the maternal mortality rate for non-Hispanic Black women stood at 69.9 deaths per 100,000 live births, 2.6 times higher than that for non-Hispanic White individuals, with significantly higher rates compared to White and Hispanic individuals.

According to March of Dimes — a nonprofit that tracks access to obstetric services in the U.S. — one major variable affecting access to maternal care is maternal care deserts.

In a 2022 report, more than two million women of childbearing age live in maternity care deserts, or areas without access to birthing facilities and/or maternity care providers.

The report found that women in maternity care deserts have to travel roughly 4.5 times farther than those with full access.

In their follow up report in 2023, more than 5.6 million women live in counties with no or limited access to maternity care services.