UPDATE: CMS released four final rules on Friday, 11/1.
- Physician Fee Schedule (PFS), scheduled for publication 12/9
- Hospital Outpatient Prospective Payment System (HOPPS), scheduled for publication 11/27
- Home Health (HH), scheduled for publication 11/7
- End-Stage Renal Disease, scheduled for publication 11/12
Starting each Spring, the Centers for Medicare & Medicaid Services (CMS) begins its annual rulemaking process to determine payment for Medicare services by provider type. These payment rules also include proposals for quality measurement and improvement, addressing health equity, and other CMS policy priorities.
These proposed rules typically have a 60-day comment period—allowing stakeholders to review the proposals and submit comments through regulations.gov. ANA’s Policy Team reviews each proposed rule, determines which proposals impact nurse practice and/or profession, and submits comment letters detailing the association’s positions on the proposed provisions.
Comments on the last proposed rule of the 2025 Medicare payment rulemaking cycle were submitted to CMS in early September. Below we detail the payment rules ANA focused on during this year’s rulemaking process and highlight our comments on each.
Physician Fee Schedule (PFS)
The PFS sets payment rates for physicians and other billing professionals, such as Advanced Practice Registered Nurses (APRNs). This year’s proposed rule included several proposals around billing codes, telehealth, screening for social determinants of health (SDOH), vaccines, quality programs, and bolstering access to behavioral health services. ANA comments focused on ensuring that the agency adequately and appropriately value the nurse in all payments, urged CMS to make permanent all telehealth flexibilities, recognize the critical role of the nurse and nurse practice, and continue to provide incentives to support and bolster the nurse workforce. Comments were due at the beginning of September, and we expect CMS to release the final rule in the coming months.
Hospital Inpatient Prospective Payment System (PPS)
CMS issued the proposed IPPS rule, which covers significantly more than inpatient hospital visits, in May. ANA’s comments covered a wide range of issues including payment incentives, health equity, public health, maternity care, climate change, and access to essential medicines. Additionally, ANA urged CMS to ensure access and payment parity for APRNs in maternal health. CMS issued the final IPPS final rule in early August, which largely finalized CMS’ proposals.
Hospital Outpatient Prospective Payment System (HOPPS)
In late July, CMS issued their calendar year 2025 HOPPS proposed rule. In addition to provisions related to outpatient care, the rule included a proposal to create an obstetric-specific Conditions of Participation (CoP). ANA’s comments urged the agency to ensure that any CoP include safe staffing levels for nurses and ensure access to APRNs, who are critical to patient access to obstetric and maternal health care. ANA also commented on raising the reimbursement rate for Esketamine, which ANA staff met with CMS about earlier this year. In addition, the comment letter included ANA’s positions on provisions related to telehealth, PPE, and health equity. Comments on this proposed rule were due in early September, and we expect CMS to issue a final rule in the coming months.
Skilled Nursing Facility (SNF) PPS
CMS issued the SNF proposed rule in May—updating SNF payment rates, quality programs, and enforcement policies. ANA expressed support for CMS’ proposals the Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) programs to address gaps in quality across SNFs and health inequities experienced by Medicare beneficiaries. In addition, we urged the agency to leverage SNF quality data to inform implementation of separate rulemaking instituting minimum staffing standards in SNFs and explore options to increase transparency on SNF spending on nursing care. CMS issued the final rule in late July, largely finalizing provisions as proposed.
Home Health (HH) PPS
The HH proposed rule, issued in late June, targets payments to HH agencies (HHAs) for services provided to beneficiaries. CMS’ proposals focused on timely admission to home health services, quality reporting and improvement programs, health equity, and other agency priorities. ANA detailed support for the proposed provisions regarding advancing health equity and improving quality. ANA also weighed in on the need for CMS to ensure nurses are part of any process or requirements to determine HHA availability and to bar therapists from conducting nursing care assessments. Comments were due at the end of August, and we expect CMS to release the final rule in the coming months.
Hospice PPS
CMS issued a May proposed rule updating hospice payments and proposing changes to quality reporting programs. ANA focused its comments on urging the agency to address gaps in quality to reduce health disparities for hospice beneficiaries. ANA also highlighted the key role of the nurse in the new Hospice Outcomes and Patient Evaluation (HOPE) assessment tools. CMS finalized the rule in July, adopting its proposed changes.
Inpatient Psychiatric PPS
In April, CMS released their annual proposed rule updating payment and policy in inpatient psychiatric programs. ANA’s comments supported CMS’ continued attention to health equity focused interventions and highlighted the importance of psychiatric mental health nurses (PMHN) to implementing patient assessment data collection. ANA also supported a new quality measure tracking a patient’s visit to an emergency room within 30 days of discharge from an inpatient psychiatric facility. Finally, we urged CMS to update this payment system to accurately account for the value of nurses and appropriately reimburse nursing care. The final rule was released in August adopting these proposals.
End-Stage Renal Disease PPS
CMS’ ESRD proposed payment rule was released in July and continues to try and fix pervasive access issues to in home dialysis. ANA comments remind CMS every year that solutions to in home access and staffing problems in the ESRD program must be created with nephrology nurses’ leadership. The agency proposed a health equity payment adjustment for clinicians that serve beneficiaries dually eligible for Medicare and Medicaid that ANA strongly supported. The final rule should be released in the next few months.