Medicare and Medicaid Programs and the Children's Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes

<RULE> DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Parts 405, 412, 413, 431, 482, 485, 495, and 512</CFR> <DEPDOC>[CMS-1808-F]</DEPDOC> <RIN>RIN 0938-AV34</RIN> <SUBJECT>Medicare and Medicaid Programs and the Children's Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Final rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This final rule revises the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; makes changes relating to Medicare graduate medical education (GME) for teaching hospitals; updates the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); and makes other policy-related changes. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> With the exception of instruction 2 (§ 405.1845), instruction 29 (§ 482.42(e)) and instruction 31 (§ 485.640(d)), this final rule is effective October 1, 2024. The regulation at § 405.1845 is effective January 1, 2025. The regulations at §§ 482.42(e) and 485.640(d) are effective on November 1, 2024. </EFFDATE> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Donald Thompson, and Michele Hudson, (410) 786-4487 or <E T="03">DAC@cms.hhs.gov</E> , Operating Prospective Payment, MS-DRG Relative Weights, Wage Index, Hospital Geographic Reclassifications, Graduate Medical Education, Capital Prospective Payment, Excluded Hospitals, Medicare Disproportionate Share Hospital (DSH) Payment Adjustment, Sole Community Hospitals (SCHs), Medicare-Dependent Small Rural Hospital (MDH) Program, Low-Volume Hospital Payment Adjustment, and Inpatient Critical Access Hospital (CAH) Issues. Emily Lipkin, and Jim Mildenberger, <E T="03">DAC@cms.hhs.gov</E> , Long-Term Care Hospital Prospective Payment System and MS-LTC-DRG Relative Weights Issues. Lily Yuan, <E T="03">NewTech@cms.hhs.gov</E> , New Technology Add-On Payments Issues. Mady Hue, <E T="03">marilu.hue@cms.hhs.gov</E> , and Andrea Hazeley, <E T="03">andrea.hazeley@cms.hhs.gov</E> , MS-DRG Classifications Issues. Jonathan Rudy, <E T="03">jonathan.rudy@cms.hhs.gov</E> , Rural Community Hospital Demonstration Program Issues. Jeris Smith, <E T="03">jeris.smith@cms.hhs.gov</E> , Frontier Community Health Integration Project (FCHIP) Demonstration Issues. Lang Le, <E T="03">lang.le@cms.hhs.gov</E> , Hospital Readmissions Reduction Program—Administration Issues. Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov</E> , Hospital Readmissions Reduction Program—Measures Issues. Jennifer Tate, <E T="03">jennifer.tate@cms.hhs.gov</E> , Hospital-Acquired Condition Reduction Program—Administration Issues. Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov</E> , Hospital-Acquired Condition Reduction Program—Measures Issues. Julia Venanzi, <E T="03">julia.venanzi@cms.hhs.gov</E> , Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program—Administration Issues. Melissa Hager, <E T="03">melissa.hager@cms.hhs.gov</E> , and Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov</E> —Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program—Measures Issues Except Hospital Consumer Assessment of Healthcare Providers and Systems Issues. Elizabeth Goldstein, <E T="03">elizabeth.goldstein@cms.hhs.gov</E> , Hospital Inpatient Quality Reporting and Hospital Value-Based Purchasing—Hospital Consumer Assessment of Healthcare Providers and Systems Measures Issues. Jennifer Tate, <E T="03">jennifer.tate@cms.hhs.gov</E> , PPS-Exempt Cancer Hospital Quality Reporting—Administration Issues. Kristina Rabarison, <E T="03">kristina.rabarison@cms.hhs.gov</E> , PPS-Exempt Cancer Hospital Quality Reporting Program—Measure Issues. Lorraine Wickiser, <E T="03">lorraine.wickiser@cms.hhs.gov</E> , Long-Term Care Hospital Quality Reporting Program—Administration Issues. Jessica Warren, <E T="03">jessica.warren@cms.hhs.gov</E> and Elizabeth Holland, <E T="03">elizabeth.holland@cms.hhs.gov</E> , Medicare Promoting Interoperability Program. Bridget Dickensheets, <E T="03">bridget.dickensheets@cms.hhs.gov</E> and Mollie Knight, <E T="03">mollie.knight@cms.hhs.gov</E> , LTCH Market Basket Rebasing. Benjamin Cohen, <E T="03">benjamin.cohen@cms.hhs.gov</E> , Provider Reimbursement Review Board. Nicholas Bonomo, <E T="03">Nicholas.Bonomo@cms.hhs.gov</E> and Tracy Smith, <E T="03">tracy.smithtaylor@cms.hhs.gov</E> , Payment Error Rate Measurement Program. <E T="03">CMMI_TEAM@cms.hhs.gov</E> , Transforming Episode Accountability Model (TEAM). Lauren Blum, <E T="03">Lauren.Blum1@cms.hhs.gov</E> , and Kristin Shifflett, <E T="03">Kristin.Shifflett@cms.hhs.gov</E> , Conditions of Participation Requirements for Hospitals and Critical Access Hospitals to Report Acute Respiratory Illnesses. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">Tables Available on the CMS Website</HD> The IPPS tables for this fiscal year (FY) 2025 final rule are available on the CMS website at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html</E> . Click on the link on the left side of the screen titled “FY 2025 IPPS Final Rule Home Page” or “Acute Inpatient—Files for Download.” The LTCH PPS tables for this FY 2025 final rule are available on the CMS website at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html</E> under the list item for Regulation Number CMS-1808-F. For further details on the contents of the tables referenced in this final rule, we refer readers to section VI. of the Addendum to this FY 2025 IPPS/LTCH PPS final rule. Readers who experience any problems accessing any of the tables that are posted on the CMS websites, as previously identified, should contact Michael Treitel, <E T="03">DAC@cms.hhs.gov</E> . <HD SOURCE="HD1">I. Executive Summary and Background</HD> <HD SOURCE="HD2">A. Executive Summary</HD> <HD SOURCE="HD3">1. Purpose and Legal Authority</HD> This FY 2025 IPPS/LTCH PPS final rule makes payment and policy changes under the Medicare inpatient prospective payment system (IPPS) for operating and capital-related costs of acute care hospitals as well as for certain hospitals and hospital units excluded from the IPPS. In addition, it makes payment and policy changes for inpatient hospital services provided by long-term care hospitals (LTCHs) under the long-term care hospital prospective payment system (LTCH PPS). This final rule also makes policy changes to programs associated with Medicare IPPS hospitals, IPPS-excluded hospitals, and LTCHs. In this FY 2025 final rule, we are finalizing our proposal to continue policies to address wage index disparities impacting low wage index hospitals. We are also finalizing our proposed changes relating to Medicare graduate medical education (GME) for teaching hospitals and new technology add-on payments. We are finalizing our proposal of a separate IPPS payment for establishing and maintaining access to essential medicines. In the Hospital Value-Based Purchasing (VBP) Program, we are finalizing our proposal to modify scoring of the Person and Community Engagement Domain for the FY 2027 through FY 2029 program years to only score six unchanged dimensions of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure, and we are finalizing our proposal to adopt the updated HCAHPS Survey measure in the Hospital VBP Program beginning with the FY 2030 program year after the updated measure has been publicly reported under the Hospital Inpatient Quality Reporting (IQR) Program for 1 year. We are also finalizing our proposal to modify scoring on the HCAHPS Survey measure beginning with the FY 2030 program year to incorporate the updated HCAHPS Survey measure into nine survey dimensions. Lastly, we provide previously and newly established performance standards for the FY 2027 through FY 2030 program years for the Hospital VBP Program. In the Hospital IQR Program, we are finalizing our proposals to add seven new measures, with modifications to our proposal to adopt the Patient Safety Structural measure, modify two existing measures including the HCAHPS Survey measure, and remove five measures. We are also finalizing our proposed changes to the validation process for the Hospital IQR Program data. We are finalizing the proposed reporting and submission requirements for electronic clinical quality measures (eCQMs) with modifications. In the PPS-Exempt Cancer Hospital Quality Reporting Program (PCHQR), we are finalizing the adoption of the Patient Safety Structural measure with modification beginning with the CY 2025 reporting period/FY 2027 program year. We are also finalizing our proposed changes to the HCAHPS Survey measure and our proposal to move up the start date for publicly displaying hospital performance on the Hospital Commitment to Health Equity measure. In the LTCH Quality Reporting Program (QRP), we are finalizing our proposals to add four assessment items to the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) and modify one assessment item on the LCDS beginning with the FY 2028 LTCH QRP. Additionally, w ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 6303k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━