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ARN Health Policy Digest - April 2024

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.

Congress Finalizes FY 2024 Appropriations

On March 23, President Biden signed the second package of final fiscal year (FY) 2024 appropriations bills into law, officially finalizing spending for FY 2024. The package includes spending for six appropriations bills, including the Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The Department of Health and Human Services, which administers many health programs that ARN members are concerned about, received $117 billion in funding, representing roughly $955 million more than the FY 2023 funding level. Here are some additional funding highlights for programs of importance to ARN members:

  • $47.081 billion for National Institutes of Health, a $400 million decrease from FY 2023
    • This includes $197.693 million for the National Institute of Nursing Research.
  • $1.5 billion for Advanced Research Projects Agency for Health (ARPA-H), consistent with final FY 2023 funding
  • $8.910 billion for Health Resources and Services Administration, a $600,000 decrease from FY 2023
    • This includes $305.472 million in total funding for the Title VIII nursing workforce development programs, a $1 million decrease from FY 2023 levels.
  • $ 9.222 billion for Centers for Disease Control and Prevention, a $4.5 million decrease from FY 2023
  • $2.580 billion for Administration for Community Living, a $15 million increase from FY 2023
    • This includes $128 million for the National Institute on Disability, Independent Living, and Rehabilitation Research, consistent with final FY 2023 funding.

CMS Releases FY 2025 IRF and SNF Proposed Rules

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released the annual Skilled Nursing Facility Prospective Payment System (SNF) and Inpatient Rehabilitation Facility Prospective Payment System (IRF) proposed rules updating Medicare payment policies and rates for SNFs and IRFs for FY 2025.

CMS proposes to update the IRF PPS payment rates by 2.8%, revise the IRF Quality Reporting Program (QRP), and seek information on the development of a five-star methodology for IRFs that can meaningfully distinguish quality of care offered by providers. Regarding the IRF QRP, CMS is proposing the adoption of four new items in the IRF-PAI as standardized patient assessment data elements under the following Social Determinants of Health (SDOH) categories: (1) Living Situation, (2) Food, and (3) Utilities. CMS is also proposing a modification of the Transportation item under the SDOH category in the IRF-PAI.

CMS is proposing an update to the SNF PPS payment rates by 4.1% and revisions to the SNF QRP and Value-Based Purchasing Program. Identical to the IRF proposed rule, beginning with the FY 2027 SNF QRP, CMS is proposing the adoption of new SDOH items in the SNF QRP Minimum Data Set. Additionally, regarding changes to the SNF Value-Based Purchasing Program, CMS is proposing to adopt a measure retention and removal policy to ensure that the measures set remain focused on the most appropriate metrics for assessing care quality in the SNF setting.

ARN will be submitting comments on these proposed rules before the May 28 deadline. We are looking for feedback from members, particularly those who work in IRF and SNF settings. Please reach out to Michaela Hollis at This email address is being protected from spambots. You need JavaScript enabled to view it. if you have input on these proposals.

MedPAC Discusses Lowering IRF Payments

On April 11, the Medicare Payment Advisory Commission (MedPAC) met to discuss alternative approaches to lowering Medicare payments for select conditions in IRFs. As ARN members know, Medicare beneficiaries who require rehabilitative care are treated in several types of facilities, including SNFs, IRFs, home health agencies, and long-term care hospitals. Medicare uses separate payment systems for each facility that result in different payments for similar cases. MedPAC's motivation for the discussion around lowering IRF payments is that MedPAC would like to see closer alignment of payments across post-acute care settings. Additionally, MedPAC believes there is evidence to suggest that some IRF admissions are not medically necessary and there is significant overlap in the patients treated in IRFs and SNFs. MedPAC did not make any official recommendations during this meeting; however, the Commission is considering lowering IRF payments to be equal to (1) SNF payments, (2) IRF costs (in aggregate), OR (3) a blend of current IRF payments and costs. ARN members can review the meeting presentation here and we will keep members updated as we learn more.

E&C Health Subcommittee Hearing on Telehealth

On April 10, the House Energy and Commerce Health Subcommittee convened a hearing focused on enhancing patients' access to telehealth. Lawmakers engaged in discussions regarding the potential extension of telehealth policies and whether this extension should be permanent or temporary. Central to the discussion were 15 legislative proposals aimed at extending and refining telehealth flexibilities, all of which garnered significant support from Committee members. Members highlighted program integrity, cost considerations, and the delivery of high-quality Medicare telehealth services. Lawmakers are very much aware of the need to address telehealth policies before the end of the year. The decision on specific provisions is anticipated to be part of a broader healthcare package expected later this year.

Recent Developments in the World of AI

The White House Office of Management and Budget (OMB) recently issued a government-wide policy to mitigate risks of artificial intelligence (AI) and harness its benefits - a follow up from President Biden's AI Executive Order directing action to strengthen AI safety and security. By December 1, 2024, Federal agencies will be required to implement safeguards when using AI. For example, when AI is used in the Federal healthcare system to support diagnostics decisions, a human being should be overseeing the process to verify the results and avoid disparities in healthcare access. The White House recognizes AI technology presents great opportunities, such as advancing public health. Therefore, OMB's policy aims to remove unnecessary barriers to Federal agencies' AI innovation.

Additionally, the US Food and Drug Administration's (FDA) released a paper, titled "Artificial Intelligence & Medical Products: How CBER, CDER, CDRH, and OCP are Working Together," outlining how the FDA intends to approach AI in medical products. The FDA's proposed four areas of focus regarding the development and use of AI across the medical product lifecycle include:

  • Fostering collaboration to safeguard public health;
  • Advancing the development of regulatory approaches that support innovation;
  • Promoting the development of standards, guidelines, best practice, and tools for the medical product life cycle; and
  • Supporting research related to the evaluation and monitoring of AI performance

Federal agencies are committed to working with patients and providers to optimize AI in a way that is best for patient outcomes. ARN will continue to keep members updated on developments and opportunities to collaborate in this space.

Notice of Funding Opportunities

Below is a list of other funding opportunities for interested ARN members.

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