ARN Health Policy Digest – January 2022
We are pleased to present the January 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.
Public Health Emergency Extended
On January 14, Secretary of Health and Human Services Xavier Becerra renewed the declaration of a public health emergency (PHE) related to the COVID-19 pandemic for an additional 90 days. The PHE declaration had previously been set to expire on January 16, leading hospitals, nursing homes, and healthcare administrators to urge Becerra on January 12 to further extend the declaration, citing pandemic waivers that have "proven critical in equipping hospitals and health systems with the tools and resources necessary to manage the recent COVID-19 surges." Along with access to the HHS Provider Relief Fund, emergency measures authorized for the duration of the PHE declaration include expanding eligibility for telehealth services, waiving the 75-hour training requirement for nursing home staff, and waiving the requirement that a Medicare patient must stay in a hospital for three days to qualify for coverage of care at a skilled nursing facility (SNF). The Biden administration has informed state governors that the PHE declaration will be extended through the end of 2022, and HHS officials have previously said the department will issue a public notice 60 days before allowing the PHE to expire.
Nurses Receive Top Marks for Honesty, Ethics
Gallup has published the results of its annual Honesty and Ethics survey, finding that for the twentieth straight year, Americans rated the honesty and professional ethics of nurses more favorably than any other profession. The survey was conducted in December 2021, and asked respondents to evaluate the different occupational groups as having very high, high, average, low, or very low ethical standards. Nurses were judged to have high or very high standards by 81 percent of respondents, with medical doctors the second-highest scoring profession at 67 percent. Nurses were first added to the annual poll in 1999 and have led the list of occupations in every year since except for 2001. Nurses, doctors, and pharmacists all saw a historic spike in favorable scores in 2020, a trend that reverted slightly to pre-pandemic averages in 2021.
MedPAC Examines Value-Based Payments
The Medicare Payment Advisory Commission (MedPAC) met January 13-14 to review the effectiveness of Medicare payment models in calendar year 2021 and to evaluate policy updates for 2023. Among other issues, the commission assessed reimbursement policies for skilled nursing facility (SNF) services, home health agency (HHA) services, inpatient rehabilitation facility (IRF) services, and long-term care hospital (LTCH) services. Additionally, the commission outlined a report on the design of a prototype value-based payment program for all post-acute care (PAC) providers and presented a model for a PAC value incentive program (VIP). Currently still in the drafting phase, the final report is to be submitted for congressional review no later than March 15, 2022, pursuant to the provisions of the Consolidated Appropriations Act, 2021.
Appropriations Debate Continues
As legislators returned from the holiday recess, senior appropriators resumed negotiations on fiscal year 2022 appropriations, which have been delayed by partisan disagreements over topline allocations for defense and non-defense discretionary spending and the inclusion of several policy riders. The continuing resolution (CR) currently serving as a stopgap funding patch is set to expire February 18, requiring lawmakers to either strike a deal on a compromise omnibus appropriations package or be forced to fall back on another temporary CR to keep the federal government open. Democratic appropriators have criticized Republicans for not presenting an offer on topline numbers to serve as a starting point for negotiations. Republicans have countered that Democrats must agree to establish parity between defense and non-defense budget increases and preserve riders including the Hyde amendment restricting funds for abortion services.
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!
Hospital Workers Struggle Amid Staff Shortage
Hospitals and long-term care facilities are facing staff shortages so precarious that many are compelling doctors and nurses to return to work after suspected COVID-19 exposure or a positive test. With over 120,000 patients nationwide hospitalized by the highly transmissible omicron coronavirus variant, some health employers argue that bringing back asymptomatic or even symptomatic staff is the only way for facilities can remain open. New CDC guidance released in December allows healthcare facilities to bring employees back to work after five days of isolation instead of ten, even if those employees have not tested negative for COVID-19. In cases where workforce shortages reach critical levels, employers may bring back staff with no isolation period. Several nursing unions have joined the American Medical Association in objecting to the practice, warning that relying on employees who may be infectious puts patients and other healthcare providers in greater danger, further exacerbating patient overloads and staff shortages.
Nurse Corps Tax Parity Act
On January 13, Senator Jeff Merkley (D-OR) introduced, the Nurse Corps Tax Parity Act of 2022 (S. 3505), co-sponsored by two Republicans and four Democrats. The bill would amend the Internal Revenue Code to exclude certain Nurse Corps payments to qualifying beneficiaries from gross personal income calculations. In recognition of the vital role that nurses have played in responding to the coronavirus pandemic, especially in rural and underserved communities, the legislation is intended eliminate the tax disparity between Nurse Corps scholarships and loan forgiveness programs, and those administered through the National Health Service Corps (NHSC). Currently, NHSC payments are not subject to federal income tax while similar Nurse Corps payments are taxable. "The Association of Rehabilitation Nurses thanks Senator Merkley for introducing the Nurse Corps Tax Parity Act," said Association of Rehabilitation Nurses President Jill Rye, "the Nurse Corps Tax Parity Act will help trainee rehabilitation nurses to fully benefit from the Nurse Corps Scholarship Program, strengthening the nursing workforce and connecting patients in underserved areas to critical rehabilitation services."
NCC Supports Pandemic Regulatory Changes
On December 20, ARN joined 44 health organizations representing the Nursing Community Coalition in a letter to congressional leadership in support of pandemic-related healthcare provider relief measures. The letter urges Congress to make permanent several regulatory waivers currently set to expire upon the end of the current public health emergency (PHE). Such waivers have afforded health providers nationwide greater flexibility to respond and adapt to the impacts of COVID-19. The signatory organizations advocate for legislative action: permanently waive requirements that Medicare patients admitted to a hospital be under the care of a physician; allow nurse practitioners (NPs) and clinical nurse specialists (CNS) to perform all mandatory visits in a skilled nursing facility (SNF); allow advanced practice registered nurses (APRNs) and certified registered nurse anesthetists (CRNAs) to practice to the top of their licensure; waive physician physical presence requirements in critical access hospitals (CAH) and physician supervision requirements in rural health clinics (RHC) and federally qualified health centers (FWHC); and remove restrictions on reimbursement for the provision of telehealth services.
Nursing Homes Cautious on Visitation Guidelines
Nursing home organizations have raised concerns with new CMS guidance opening visitation for residents during the latest wave of coronavirus infections driven by the omicron variant. While nursing homes say the guidance restricts their ability to limit visits for safety reasons, CMS and beneficiary advocates have argued that visitation is necessary and that restrictions on visitors earlier in the pandemic were ineffective. On January 6, the agency released Frequently Asked Questions to clarify earlier guidance on visitation during the pandemic, stating "visitation must be permitted at all times with very limited and rare exceptions, in accordance with residents' rights." Medicare beneficiary advocates have supported the CMS decision, citing the detrimental physical and mental effects of isolation on nursing home residents and arguing that visitation can proceed safely provided proper guidelines for reducing transmission risk are followed. However, CDC officials have advised nursing homes that recent guidance recommending a shorter isolation period for those with COVID-19 infection is meant for the general public and should not be applied to nursing home residents, staff, or visitors, and encouraged caution on the part of all visitors especially to vulnerable or at-risk residents.
Telehealth Stakeholders Engage Congress
Stakeholder organizations including the American Medical Association (AMA), American Telemedicine Association (ATA), and Healthcare Leadership Council (HLC) are renewing efforts to persuade Congress to extend, and eventually make permanent, regulatory waivers that allowed a significant expansion of telehealth services in 2021. Citing studies published by the HHS Office of Inspector General (OIG) which found that expanding reimbursement for telehealth did not disrupt patient-provider relationships and that permanently waiving geographic and site limitations could allow state Medicaid programs to provide improved mental health care, health organizations have urged lawmakers to codify telehealth flexibilities beyond the end of the COVID-19 public health emergency (PHE). Bipartisan legislation including the Telehealth Extension Act (H.R. 6202), Telehealth Modernization Act (S. 368 / H.R. 1332), and CONNECT for Health Act (S. 1512 / H.R. 2903) could advance this year, say stakeholders, and CMS could also take action to cement new telehealth authorities by including them in the HHS statutory definition of telehealth services.
Johnson Chosen to Lead HRSA
On December 17, Secretary of Health and Human Services Xavier Becerra announced the appointment of Carole Johnson to serve as Administrator of the Health Resources and Services Administration (HRSA), after the agency was without a permanent head for most of 2021. Johnson most recently worked as Testing Coordinator for the White House COVID-19 Response Team. Prior to joining the Biden administration, Johnson served as Commissioner of the New Jersey Department of Human Services (DHS), and she also helped oversee responses to Ebola and Zika virus outbreaks during the Obama administration as a senior health policy advisor on the White House Domestic Policy Council (DPC). In a statement, Becerra called Johnson a leader "with deep health expertise who has been integral to the Biden-Harris Administration's fight against COVID-19," and praised her "strong track record of getting results at the state and national level."
2023 Annual Conference
Presented both virtually and in-person at the Rhode Island Providence Convention Center in Providence, Rhode Island, we look forward to sharing more information with you about the speakers, presentations, and more.