ARN Health Policy Digest – August 2021
We are pleased to present the August 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 of rehabilitation nurses.
Biden Administration to Mandate COVID-19 Vaccines in Nursing Homes
The Biden Administration intends to require that nursing home staff receive COVID-19 vaccinations as a condition for payment under Medicare and Medicaid. As of August 8, an average of 62% of nursing home staff were vaccinated with wide variation among states – ranging from a rate of 88% in Hawaii to 44% in Louisiana. Nursing home industry groups, including LeadingAge and the American Health Care Association and National Center for Assisted Living, have expressed concern about the mandate, citing the existing nursing home workforce shortage. The Administration is expected to issue the mandate in September.
Fiscal Year 2022 Appropriations
After a week of deliberation, the House voted 219-208 on July 29 to pass H.R. 4502, the fiscal year 2022 Labor-HHS-Education (LHHS) Appropriations bill that served as a legislative vehicle for a seven-bill appropriations 'minibus.' The bill, with a combined $597.7 billion in discretionary budget authority, includes the LHHS, Agriculture-FDA, Energy and Water, Financial Services, Interior-Environment, Military Construction-VA, and Transportation-HUD Appropriations bills. The bill included $314 million (+19%) for Tile VIII Nursing Workforce Development Programs, $201 million (+15%) for the National Institute of Nursing Research (NINR), and nearly $125 million (+10%) for the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). A full summary of appropriations relevant to ARN is available here.
GAO Report Raises SNF Nurse Staffing Concerns
A Government Accountability Office (GAO) report released on August 9 found that less that one quarter of skilled nursing facilities (SNF) treating Medicare beneficiaries frequently met staffing thresholds for minimum RN and total nurse staffing needed to avoid facility quality problems. Medicare spent nearly $28 billion in 2019 on short-term care for 1.5 million beneficiaries in SNFs after hospital stays, and the study's authors estimate Medicare spent over $5 billion in 2018 on critical incidents that CMS defines as potentially preventable, consisting mostly of about 377,000 hospital readmissions occurring within 30 days of the SNF admission. In addition to recommending that Congress authorize HHS to report additional staffing data, GAO makes three key recommendations for executive action: directing CMS to report weekend decreases in RN and total nurse staffing levels on the Care Compare website; to report minimum RN and total nurse staffing thresholds below which SNF residents are at increased risk of quality problems; and to assess the feasibility of incorporating these additional metrics into the Five-Star Quality Rating System.
More Heath Organizations Join Vaccine Letter
One hundred state, national, and international medical societies have joined an open letter advocating that all health care and long-term care employers require that all employees receive a COVID-19 vaccine. Noting the ethical commitment of healthcare providers to protect the patients under their care and recognizing that a significant number of healthcare workers remain unvaccinated, the letter's signatories call for employers to respond collectively to the nationwide spread of the Delta coronavirus variant and resurgent numbers of infections, hospitalizations, and deaths, especially among unvaccinated populations. Since ARN became an original signatory, several other major medical societies have expressed support for mandating vaccines in healthcare settings. Almost 1,500 hospitals nationwide are mandating vaccination for their employees.
CMS Issues IRF PPS Final Rule
On July 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). CMS is updating the IRF PPS payment rates by 1.9 percent based on the IRF specific market basket estimate of 2.6 percent, less than a 0.7 percentage point productivity adjustment. The new FY 2022 IRF PPS payment rates and policies will go into effect on October 1, 2021. The rule also finalizes policies under the IRF Quality Reporting Program (QRP) for FY 2022: a proposal to modify the number of quarters used for public reporting of IRF quality measures due to the ongoing COVID-19 public health emergency (PHE), and the adoption of the COVID-19 Vaccination Coverage among HCP Measure to assess whether IRFs are taking steps to limit the spread of COVID-19 among their personnel.
HHS Identifies "Long COVID" as a Potential Source of Disability
On July 26, the Department of Health and Human Services (HHS) issued new guidance on the treatment of "long COVID" as a disability under the Americans with Disabilities Act (ADA), §504 of the Rehabilitation Act of 1973, and §1557 of the Patient Protection and Affordable Care Act. Developed by the HHS Office for Civil Rights in consultation with the Civil Rights Division of the Department of Justice (DOJ), the guidance clarifies that a diverse array of physical and mental long COVID symptoms can be considered a disability if they substantially limit one or more major life activities, and that individuals whose long COVID qualifies as a disability are entitled to the same protections from discrimination as any other person with a qualifying disability. The guidance also enumerates federal agency resources available to people suffering from long COVID symptoms. During a Rose Garden ceremony commemorating the 1990 passage of the landmark ADA legislation, President Biden said that "we're bringing agencies together to make sure Americans with long COVID, who have a disability, have access to the rights and resources that are due under the disability law, which includes accommodations and services."
If you haven't already, we recommend that you visit ARN's COVID-19 Resource page on the ARN website for the latest information and resources for rehabilitation nurses.