ARN Health Policy Digest – February 2022

We are pleased to present the February 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.

Appropriators Target Omnibus Deal 

Senior House and Senate appropriators have agreed to a "framework" proposal to allow committee staff to compile a Fiscal Year 2022 omnibus appropriations package. The framework provides for increases to defense and non-defense discretionary spending, bringing Congress a step closer to resolving a regular appropriations process that has been delayed by months and necessitated multiple short-term continuing resolutions to keep federal agencies open. Congress passed and the President signed another continuing resolution, funding the federal government at Fiscal Year 2021 levels until March 11 to allow House and Senate appropriators to reach a final agreement for Fiscal Year 2022. 

Action Alert – ​ Tell Your legislators to Support ARN Appropriations Priorities! 

By passing another continuing resolution, Congress has again failed to complete its appropriations work for fiscal year 2022. Congress needs to hear from rehabilitation nurses on the need to pass federal funding for nursing workforce development, rehabilitation research, and other programs important to rehab nurses and their patients. Now is the time to contact your representatives to tell them about the importance of providing adequate funding for the nursing workforce, nursing and rehabilitation research, and programs for traumatic brain injury!

Please take a few moments to click here and send your Representative and Senators an email message asking them to adequately fund ARN's policy priorities to ensure people have access to the high-quality treatment and the new, cutting-edge therapies they need and deserve. Your communication to policymakers can make a difference!

NeuroRehab Common Data Elements 

The National Institute of Neurological Disorders and Stroke (NINDS) and the National Center for Medical Rehabilitation Research published the first iteration of the NeuroRehab Common Data Elements (CDE) for use in neurorehabilitation clinical research. Version 1.0 of the NeuroRehab CDE project is intended to create a centralized resource of existing NINDS CDEs for the use of neurorehabilitation researchers, identify existing domain gaps in the NINDS/NIH CDEs, and determine areas for future development. Several members of the Disability and Rehabilitation Research Coalition (DRRC), of which ARN is a member, contributed to the development of the CDEs. Further guidance on Version 1.0 of the CDEs and other searchable data standards for neurorehabilitation can be found on the NINDS website.

ARN Comments on PCORI Agenda 

On January 28, ARN submitted comments in response to the proposed PCORI research agenda. The establishment of a research agenda fulfills the provisions of the agency's 2019 reauthorization and builds on the recently adopted PCORI National Priorities for Health. ARN strongly supported the proposed research agenda and urged PCORI to emphasize research on diverse populations including individuals with chronic illness, intellectual or developmental disabilities or physical disabilities resulting from a stroke, spinal cord injury, or traumatic brain injury. ARN also supported the inclusion of research that fills evidence gaps identified by patients and stakeholders representative of diverse patient populations and settings, with the goal of achieving health equity and eliminating health disparities. ARN urged PCORI to recognize patients requiring rehabilitative care – including patients with disabilities – in developing a conceptual understanding of diverse patient populations in need of representation and prioritization. Similarly, ARN also pointed out that developing such concepts of patient diversity should also include a focus on diversity of setting, recognizing that the needs of diverse patient populations include receiving care provided in outpatient, inpatient, and post-acute settings.

Provider Organizations, Legislators Raise Health Staffing Concerns 

Responding to the growing strain on health workforces nationwide due to the spread of the omicron coronavirus variant, the American Hospital Association and the American Health Care Association/National Center for Assisted Living penned a joint letter to White House COVID-19 Response Team Coordinator Jeff Zients on January 27 raising "serious concerns" that direct staffing agencies have engaged in exploitative and anticompetitive practices. The letter echoed many of the claims made three days earlier by a group of 200 lawmakers led by Rep. Peter Welch (D-VT) and Morgan Griffith (R-VA) in a January 24 letter to Zients. The authors of both letters alleged "countless examples" of direct staffing agencies abusing their market positioning and the ongoing shortage of nurses and other desperately needed health personnel to inflate prices above competitive levels and retain up to 40 percent of those rates for themselves, degrading the ability of hospitals and long-term care facilities to provide adequate care to patients. Noting that these concerns are with the staffing agencies exclusively and not with the personnel they represent, the letters called on the White House to ensure that the Federal Trade Commission and other regulatory authorities investigate any abuses of antitrust or consumer protection laws appropriately. 

CPR Comments on 2023 NBPP 

ARN and other members of the Coalition to Preserve Rehabilitation (CPR) submitted final comments on the proposed 2023 CMS Notice of Benefit and Payment Parameters (NBPP) to CMS Administrator Chiquita Brooks-LaSure on January 27. Signatories urged CMS to establish at least a 60-day comment period for the annual rulemaking and supported maintaining essential health benefits for rehabilitative services and devices covered under the Affordable Care Act (ACA). Responding to CMS proposals on ensuring network adequacy for ACA exchange health plans, signatories strongly urged CMS to include IRFs, CORFs, and LTCHs in the network adequacy review process, expand access to telehealth care, and prevent beneficiaries from having to face geographic and transportation-based barriers to accessing covered services. Finally, the comments encouraged CMS to develop policies to broaden the use of Current Procedural Terminology (CPT) modifiers relating to rehabilitative care, and to prevent discriminatory benefit limitations in proposed evidence-based coverage standards.

HRSA Highlights 

HRSA announced over in Provider Relief Fund Phase 4 General Distribution payments to more than 7,600 healthcare providers impacted by the COVID-19 pandemic on January 25, after releasing nearly $9 billion in PRF funding during December. The combined $11 billion in PRF Phase 4 payments has now been distributed to more than 74,000 providers. In addition, HRSA distributed ARP Rural payments of nearly $7.5 billion to more than 43,000 rural providers in December. In total, HRSA made more than 100,000 provider relief payments in calendar year 2021.

On January 20, HRSA announced the disbursement of $103 million in American Rescue Plan funds to forty-five individual grantees, to improve retention of healthcare workers and respond to critical nationwide staffing levels by reducing burnout and promoting mental health in the healthcare workforce. Grant awards will fund evidence-informed programs, practices, and training, and will include a specific focus on providers based in underserved and rural communities.

HRSA's 2021 health workforce fact sheet and annual agency review highlighted historic investments in growing the health workforce, including supporting the largest-ever cohort of health care providers through scholarship and loan repayment aid in return for a commitment to practice in underserved communities; 22,700 clinicians participating in the National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery Loan Repayment Program provided care to over 23.6 million patients in underserved communities in 2021.

Electronic Health Records RFI 

On January 21, the HHS Office of the National Coordinator for Health IT (ONC) issued a request for information (RFI) notice seeking public comments regarding electronic Prior Authorization (ePA) standards. Many health provider advocates have previously supported the incorporation of ePA in electronic health records, although payers and healthcare IT developers have approached prior authorization needs in an ad hoc fashion, leading to issues with efficiency and interoperability of different electronic records interfaces. In response to the burden placed on healthcare providers, additional administrative frictions incurred by payers, and risks imposed on patients by delaying care, ONC is seeking input on ePA standards, implementation specifications, and certification criteria that could be adopted within the ONC Health IT Certification Program, to inform potential future rulemaking. To receive consideration, any written or electronic comments on the RFI must be submitted to the ONC no later than 5:00 PM on March 22, 2022.