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ARN Health Policy Digest – April 2023

Health Policy & Advocacy

We are pleased to present the April issue of the ARN Health Policy Digest. This member benefit provides updates on health policy and legislative and regulatory developments that may be of interest to rehabilitation nurses.

The Latest on Budget and Appropriations

House Speaker Kevin McCarthy (D-CA) revealed the House Republican's long-awaited budget plan, which aims to increase the federal debt limit while also reducing and capping the growth of discretionary spending. Specifically, the proposal would raise the debt limit by $1.5 trillion, or through March of next year, and would cut federal funding by $130 billion in FY 2024. Additionally, the bill proposes to revoke any remaining COVID-19 relief, prevent implementation of President Biden's student loan cancellation policies, expand work requirements for Medicaid and food stamps, repeal energy provisions included in the Inflation Reduction Act (IRA), and rescind the IRA's IRS enforcement funding. You can view a summary of the budget plan here and see the bill text here.

President Biden, along with House and Senate Democratic leaders, is strongly opposed to McCarthy's proposal and continue to reinforce the need to pass a clean debt ceiling increase without spending cuts. Biden and McCarthy have not met since February 1 to discuss the debt limit; however, as we get closer to a potential default this Summer, we are hopeful that negotiations will resume. We also expect the House to release their FY 2024 appropriations bills in the coming weeks. We have heard that there is a chance that funding for Labor-HHS programs may receive cuts anywhere from 5-40%. In the meantime, ARN will continue to advocate for the highest possible funding levels for the health programs of interest to our nurses and patients.

CMS Releases FY 2024 IRF and SNF Proposed Rules

On April 3, the Centers for Medicare & Medicaid Services (CMS) released the FY 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Proposed Rule. The rule includes proposed updates to Medicare payment policies and rates under the IRF prospective payment system and quality reporting program for the upcoming year. CMS estimates that overall IRF payments for FY 2024 would increase by 3.7 percent compared to FY 2023 payments. The proposed rule and a fact sheet are available for review.

CMS also released the FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System Proposed Rule (CMS 1779-P). In addition to updates to Medicare payment rates and policies, the proposed rule also includes proposals for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program for FY 2024 and future years. CMS estimates that the aggregate impact of the payment policies in this proposed rule would result in a net increase of 3.7 percent in Medicare Part A payments to SNFs in FY 2024. The fact sheet and proposed rule are available for review.

ARN is reviewing the IRF and SNF proposed rules in detail and looks forward to providing comments before the deadlines on June 2 and 5, respectively.

MedPAC Meets to Discuss Medicare Payment for SNFs and Telehealth

On April 13, the Medicare Payment Advisory Commission (MedPAC) met to assess the need for Medicare Safety Net payments for Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs). MedPAC commissioners reviewed the Commission's approach to identify and support safety net providers that serve low-income Medicare beneficiaries and discussed findings from an analysis of the relationship between SNF and HHA low-income beneficiary volume and financial performance under Medicare. Commissioners determined that they will not recommend supporting safety-net payments at this time. A transcript and PowerPoint slides are available for review.

The next day, on April 14, MedPAC reconvened to discuss the Congressionally mandated report on telehealth. Commissioners discussed temporary expansions of telehealth during and after the PHE, MedPAC's policy option for telehealth covering after the PHE that was included in their March 2021 report to Congress, and the impact of telehealth expansions on quality, access, and cost during the COVID-19 pandemic. Findings highlighted by MedPAC staff aligned with the Commission's policy option, but they noted there needs to be more evidence before making any permanent decisions and recommendations. The PowerPoint slides from the meeting can be found here.

OIG Report Highlights CMS Reporting Failures​

The Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released a report detailing findings from its audit which highlighted that CMS failed to accurately report on health, fire safety, and emergency preparedness for nursing homes. OIG selected a random sample of nursing homes nationwide and compared deficiencies that were reported on Care Compare with State survey agencies. After analyzing the deficiencies, OIG recommended that CMS (1) correct the inaccurately reported deficiencies that were identified; and (2) strengthen its process for reviewing these results.

Study Finds Increasing Pandemic-Related Burnout for Nurses​

The National Council of State Boards of Nursing released results from its research study, titled "Examining the Impact of the COVID-19 Pandemic on Burnout & Stress Among U.S. Nurses." The purpose of the study was to examine how the nursing workforce was impacted by the COVID-19 pandemic. Below is a list of the key findings from this research:

  • Approximately 100,000 registered nurses (RNs) left the workforce during the pandemic in the past two years due to stress, burnout, and retirements.
  • 610,388 RNs reported an "intent to leave" the workforce by 2027 due to stress, burnout, and retirement. 188,962 additional RNs younger than 40 years old reported similar intentions.
  • One-fifth of RNs nationally are projected to leave the health care workforce.
  • 62% of the sample reported an increase in their workload during the pandemic.
  • A quarter to half of nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) "a few times a week" or "every day."
  • Issues were most pronounced with nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce in the past two years.
  • Licensed practical/vocational nurses, who generally work in long-term care settings caring for the most vulnerable populations, have seen their ranks decline by 33,811 since the beginning of the pandemic. 

 Notices and Funding Opportunities

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