Annual CMS rules support underserved, under-resourced communities, promote value-based care

Editor's Note

Addressing social determinants of health (SDOHs), strengthening emergency preparedness, and improving maternal heath are among the top priorities of the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rules released April 10. These and other efforts aim to support Medicare beneficiaries in historically underserved and under-resourced communities and promote value-based care, the AGENCY reports. Highlights include:

• Rates are projected to increase to 2.6% for acute care hospitals participating in the Hospital Inpatient Quality Reporting program, and that are “meaningful” electronic health record users.
• CMS proposes to increase the LTCH PPS standard federal payment rate by 2.8%.
• Efforts to foster equity include better accounting for resources devoted to caring for people experiencing housing insecurity (which builds on last year’s increase in payments to hospitals caring for people experiencing homelessness); adding new SDOH requirements and data elements into LTCH quality reporting; and promoting access to treatments in rural and undeserved communities. 
• To boost emergency preparedness, CMS proposes a permanent streamlined data reporting structure for COVID-19, influenza, and respiratory syncytial virus (RSV), with additional reporting that could be activated in the event of an emergency.
• Building on lessons of past models, the proposal for the mandatory Transforming Episode Accountability (TEAM) Model is a mandatory episode-based alternative payment model for acute care hospitals to coordinate care and assume responsibility for costs and care quality for 30 days after hospital discharge of Medicare patients undergoing certain surgeries. To reduce costs, TEAM would “incentivize coordination between care providers during a surgery, as well as the services provided during the 30 days that follow, and require referral to primary care services to support continuity of care and drive positive long-term health outcomes,” CMS reports.   
• Noting that poor maternal health access disproportionately affects non‑Hispanic Black Individuals, American Indian and Alaska Native individuals, low-income individuals, and individuals with disabilities, CMS is soliciting comments on how to improve access to quality maternal care through hospital Conditions of Participation (CoPs), including requirements and structure for a possible future obstetrical services CoP and a request for information on the use of the Medicare IPPS payment rates for maternity care by other payers.