The Centers for Medicare & Medicaid Services (CMS) has released the fiscal year (FY) 2025 proposed rule for Hospital Inpatient Prospective Payment Systems (IPPS). The proposed 2025 CMS Hospital IPPS rule includes a 3 percent rate increase which is reduced by a 0.4 percent productivity adjustment resulting in a proposed payment increase of 2.6 percent over FY 2024. Blood and blood components are excluded from the list of essential medicines in the proposed 2025 CMS Hospital IPPS rule , “due to differences in their supply chains.” The essential medicines list would provide some hospitals with funding to cover the IPPS portion of creating a six-month supply stockpile of these medications. America’s Blood Centers (ABC) has previously advocated for the inclusion of blood and blood products as blood reimbursement reform is a key part of the ABC Advocacy Agenda and remains a priority for the blood community.
The proposed 2025 CMS Hospital IPPS rule also specifies that during a public health emergency (PHE), the HHS Secretary can require hospitals to report on their level of blood components without requiring notice and comment rulemaking. CMS pays hospitals for inpatient stays using the IPPS, which sets base payment rates for a patient’s stay based on the patient’s diagnosis and severity of illness. A hospital is not paid for the cost of providing care to a specific patient, but instead is given a single payment based on the patient’s diagnostic related group (DRG) with certain add-ons and adjustments.
Additionally, hospitals are not reimbursed separately for blood products. Each year, CMS must reassess the payment rate to reflect hospital reporting of the price of goods and services used to treat all Medicare patients (known as the market basket).
The proposed rule will be published in the Federal Register on May 2nd. CMS is accepting comments on the proposed 2025 CMS Hospital IPPS rule until June 10th. A summary of the proposed rule changes is available on the CMS website. ABC will continue to provide updates on its advocacy efforts as they become available.