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ARN Health Policy Digest – December 2023

Health Policy & Advocacy

We are pleased to present the December 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.

Updates on the FY 2024 Appropriations Process 

Congress will recess for the holiday leaving the future of fiscal year (FY) 2024 appropriations undecided. The latest action by Congress saw the passage of a first-of-its-kind laddered continuing resolution (CR) on November 14. This CR extends funding for four appropriations bills-Agriculture, Military Construction-VA, Energy & Water, and Transportation HUD-until January 19, while the remaining eight, including Labor-HHS and Defense, are extended to February 2. The Senate will reconvene on January 8, followed by the House on January 9. Upon returning from the holiday break, both chambers will be under pressure to reach critical decisions as they face the approaching CR deadlines.

If a CR persists into the new year, a one-percent across-the-board sequester will be imposed-per the debt ceiling agreements. However, if Congress can finalize spending bills by the end of April, this cut may be avoided due to the timeline of its implementation by the Office of Management and Budget. If Congress is unable to finalize FY 2024 appropriations by the end of April, the implications of a continued CR and the question of whether the sequester will be triggered are still somewhat unknown.

It's important for ARN members to understand the implications of a CR. Operating under short-term resolutions means a hold on new grants and a cap on existing ones, creating uncertainties for researchers and staff dependent on these funds. A full-year CR is effectively a cut, with no allowance for inflation or growth. With this in mind, we will continue to keep ARN members updated as we learn more.

Senators Unveil Bipartisan Legislation to Challenge CMS' Nursing Home Staffing Rule 

On December 6, a bipartisan group of senators introduced the Protecting Rural Seniors' Access to Care Act which would block the Centers for Medicare & Medicaid Services' (CMS) proposed staffing minimums for the nursing home sector. The legislation, sponsored by Senators Deb Fischer (R-NE), Robert Marshall (R-KS), James Lankford (R-OK), Jon Tester (D-MT), Kyrsten Sinema (I-AZ), Joe Manchin (D-WV), Roger Wicker (R-MS), Susan Collins (R-ME), and Angus King (I-ME), would prohibit the Department of Health and Human Services (HHS) from finalizing the proposed nursing home staffing rule and would establish an advisory panel on nursing home staffing. The advisory panel would be composed of members representing urban and rural communities and would submit a report to Congress that examines workforce shortages and makes recommendations to strengthen the workforce. The lawmakers state that the proposed rule would exacerbate staffing shortages and inflict high costs on nursing facilities. Supporters of CMS' proposed rule cite low wages, poor working conditions, and deliberate understaffing as the causes of the workforce shortage. A House version of the bill was introduced in September by Representative Michelle Fischbach (R-MN) and has acquired seventeen co-sponsors. 

MedPAC Unveils Draft Payment Recommendations for SNFs and IRFs 

Earlier this month, the Medicare Payment Advisory Commission (MedPAC) met to review Medicare's fee-for-service payment policies and make payment update recommendations to Congress. For the March 2024 Report to the Congress, MedPAC discussed whether Medicare payments to skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are adequate and how they should be updated in 2025. Specifically, MedPAC's draft recommendations to Congress call for a reduction to the 2025 payment rate for SNFs and IRFs by 3% and 5%, respectively. The commission's draft recommendations will be formally voted on in January 2024, and if finalized, the recommendations will be included in MedPAC's March 2024 report to Congress. For more information, a transcript and Power Point presentations from the meeting are available for review here.

Notice of Funding Opportunities 

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

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