Data / Federal rules / 2024-25521
Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities
The Centers for Medicare & Medicaid Services published this final rule in the Federal Register on November 27, 2024. It took effect on January 1, 2025.
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What the agency says
This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2025 based on our continuing experience with these systems. We describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. Also, this final rule updates the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, and Hospital Inpatient Quality Reporting Program. We also summarize information received in response to a Request for Information on potential modifications to the Safety of Care measure group in the Overall Hospital Quality Star Rating methodology. In this final rule, we are also finalizing our proposal to narrow the description of "custody" in the Medicare payment exclusion rule and to revise the special enrollment period criteria for formerly incarcerated individuals. We are also finalizing our Medicaid and Children's Health Insurance Program (CHIP) continuous eligibility provisions. We are also finalizing the proposal to reduce the review timeframe for standard prior authorization requests for certain covered outpatient department services paid under the OPPS from 10-business days to 7-calendar days. Further, this rule finalizes updates to the Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) in an effort to advance the health and safety of pregnant, birthing, and postpartum women. This rule also finalizes our proposed policy to separately pay Indian Health Service (IHS) and Tribal hospitals for high-cost drugs furnished in hospital outpatient departments through an add-on payment in addition to the all-inclusive rate (AIR) under the authorities used to calculate the AIR starting January 1, 2025. Finally, we are finalizing exceptions to the Medicaid clinic services four walls requirement for IHS and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas.
Key facts
- Document number
- 2024-25521
- Type
- Final rule
- Action
- Final rule with comment period
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- November 27, 2024
- Takes effect
- January 1, 2025
- Dates
- Effective date: The provisions of this rule are effective January 1, 2025.
- Docket
- CMS-1809-FC
- Regulation ID (RIN)
- 0938-AV35
- Code of Federal Regulations
- 42 CFR 406; 42 CFR 407; 42 CFR 410; 42 CFR 411; 42 CFR 416; 42 CFR 419; 42 CFR 435; 42 CFR 440; 42 CFR 457; 42 CFR 482; 42 CFR 485
- Topics
- Administrative practice and procedure; Aid to Families with Dependent Children; Diseases; Grant programs-health; Health facilities; Health insurance; Health professions; Hospitals; Laboratories; Medicaid; Medicare; Privacy; Reporting and recordkeeping requirements; Rural areas; Supplemental Security Income (SSI); Wages; X-rays
- Pages
- 683
Other documents from the Centers for Medicare & Medicaid Services
Everything from the Centers for Medicare & Medicaid Services · Rules on administrative practice and procedure · Rules on aid to families with dependent children · Rules on diseases · Published in November 2024
Read from the Federal Register API, last updated 2026-10-23. The document on federalregister.gov is the official record; dates and dockets can change through later corrections. Free to reuse with credit to SpecStream under CC BY 4.0.