Our work shaping and reporting on national mental health policy is made possible through a capacity grant from the Perigee Fund.

In November 2024 the Centers for Medicare and Medicaid Services (CMS) released the CY 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule*. This rule establishes the first-ever maternal health and safety standards for hospitals while addressing barriers to healthcare for underserved communities, including formerly incarcerated individuals.

Obstetric Care 

CMS has mandated baseline health and safety requirements for hospitals and Critical Access Hospitals (CAHs) providing obstetrical services. These requirements focus on:

  • Organizational Structure: Clear guidelines for obstetric unit operations.
  • Staff Training: Evidence-based maternal health practices to improve competency.
  • Quality Assessment: Updated performance improvement programs designed to elevate care quality.

According to a Fact Sheet from CMS dated November 1, 2024, “These final requirements ensure that all Medicare and Medicaid participating hospitals and CAHs offering these services are held to a consistent standard of high-quality maternity care that protects the health and safety of pregnant, birthing, and postpartum patients.”

“CMS is committed to addressing our nation’s maternity care crisis. Today, we are establishing the first-ever maternal health and safety standards for hospitals,” said CMS Administrator Chiquita Brooks-LaSure. “The CY 2025 hospital Outpatient Prospective Payment System final rule expands access to behavioral health services, increases access to certain high-cost drugs for those facing cancer in tribal communities, and addresses barriers to Medicare coverage for those formerly incarcerated.”

Behavioral Health and Pain Management Innovations

CMS’ final rule also works to reduce opioid use and enhance pain management alternatives. Additional payments will be provided for non-opioid drugs and medical devices with proven efficacy in reducing opioid reliance post-surgery. This policy not only addresses the opioid crisis but also provides safer recovery options for patients.

Additionally, the updated rule adjusts payment rates for intensive outpatient program services provided by hospital outpatient departments and Community Mental Health Centers to support individuals with acute mental health conditions or substance use disorders.

Impact on Maternal Mental Health

The new CMS standards impact maternal mental health by emphasizing hospital readiness for obstetric emergencies, including perinatal mental health crises. The CY 2025 OPPS/ASC Payment System Final Rule Fact Sheet highlights that CMS is finalizing a requirement that “OB services be well organized and provided in accordance with nationally recognized acceptable standards of practice for the health care (including physical and behavioral health) of pregnant, birthing, and postpartum patients.” Additionally, “Emergency Services CoP (conditions of participation) to improve facility readiness in caring for emergency services’ patients, including pregnant, birthing, and postpartum women.” We anticipate reporting on the outcomes of these requirements once finalized. 

*This document is unpublished and will be published on 11/27/2024. Once it is published, it will be available on this page in an official form. Until then, you can download the unpublished PDF version.