Health Policy Digest - April 2025

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.

House Republicans Vote to Pass Senate Budget Resolution

Earlier this month, the House voted to adopt the Senate-passed budget resolution, officially unlocking the reconciliation process. Passing this legislation was the first critical step for Republicans to enact President Trump's agenda – including tax cuts, border security and immigration enforcement, increasing the debt ceiling, and more – without Democratic support.

With support from both House and Senate Republicans, the budget resolution provides instructions for lawmakers to craft a reconciliation package that cuts taxes by up to $5.3 trillion over ten years and raises the debt ceiling by $5 trillion, while only requiring $4 billion in spending cuts. It's important to note that the House's initial budget instructions direct committees of jurisdiction to find over $1.5 trillion in spending cuts – a target that House Speaker Mike Johnson (R-CA) has committed to uphold, promising his Republican colleagues that they could oust him from the speakership if he fails to deliver on his fiscal promises. Additionally, to gain the favor of House GOP hardliners, Senate Majority Leader John Thune (R-SD) agreed to the larger $1.5 trillion spending cuts; however, this number is giving some GOP senators pause due to concern over Medicaid. Some Republicans, including Senator Josh Hawley (R-MO), have said they will not vote to cut Medicaid benefits.

As Congress begins hashing out the details of the reconciliation package, we expect that cuts to the Medicaid program will still be considered by the House Energy & Commerce (E&C) Committee, which has been charged with finding $880 billion in savings from programs within its jurisdiction. While E&C Chair Brett Guthrie (R-KY) stated that Republicans could meet their target without reducing Medicaid benefits, the Congressional Budget Office disagrees. 

Budget "Passback" Reveals Trump's Plan for Major Cuts to HHS

A leaked version of the White House's budget plans for the Department of Health and Human Services (HHS) was released on April 16. This "passback" outlines the Trump Administration's budget and reorganization for HHS. Included in the plan is a one-third cut in spending, which is approximately $80 billion. Along with detailing the major financial cuts to HHS, the document outlines plans for restructuring the agency.

Specifically, this leaked budget includes proposals to move the Health Resources and Services Administration (HRSA) Title VIII nursing workforce programs into the newly created Administration for a Healthy America (AHA). While the NURSE Corps program was preserved, the following programs will be eliminated: (1) Advance Education Nursing; (2) Nurse Practitioner Optional Fellowship Program; (3) Nursing Workforce Diversity; (4) Nurse Education, Practice, and Retention; and (5) Nurse Faculty Loan Program.

The budget also proposes to eliminate key research agencies. This includes a 40% cut to funding for the National Institutes of Health (NIH), which would be carried out through the consolidation and elimination of institutes such as the National Institute on Minority Health and Health Disparities and the National Institute of Nursing Research. Additionally, the budget dismantles the Administration for Community Living (ACL) and eliminates the National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR). Surviving ACL programs were moved under the budget for the Centers for Medicare & Medicaid Services (CMS).

Lastly, the budget proposes to eliminate the Center for Disease Control and Prevention (CDC) Traumatic Brain Injury programs as well as the National Center for Chronic Disease Prevention and Health Promotion.

HHS Reorganization

Just a few weeks before the leaked budget was released, HHS unveiled a major reorganization of its structure and agencies. A number of independent agencies within HHS are getting consolidated or rolled into different offices within HHS. Specifically, HHS' 28 divisions will be consolidated into 15. Additionally, the restructuring will reduce HHS's workforce by another 10,000 individuals after another 10,000 employees accepted the administration's early retirement offer. These changes are expected to have significant implications for the agencies and programs prioritized by ARN, particularly HRSA, CDC, NIH, and NIDILRR.

Update on Trump's Health Nominees

The Senate has voted to confirm three of President Trump's health nominees, including Dr. Jay Bhattacharya to serve as the Director of the NIH, Dr. Martin Makary to serve as the Food and Drug Administration (FDA) Commissioner, and Dr. Mehmet Oz to serve as Administrator of CMS. Additionally, after pulling Dr. Dave Weldon's nomination for CDC Director, President Trump has officially nominated current CDC Acting Director Dr. Susan Monarez.

CMS Releases FY 2026 IRF and SNF Proposed Rules

CMS released the annual Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and Inpatient Rehabilitation Facility (IRF) PPS proposed rules updating Medicare payment policies and rates for SNFs and IRFs for fiscal year (FY) 2026.

CMS proposes to update the IRF PPS payment rates by 2.6% and revise the IRF Quality Reporting Program (QRP). Specifically, CMS is proposing to remove measures and data elements within the IRF QRP related to COVID-19 vaccination and social determinants of health (SDOH), respectively. CMS is also seeking input from stakeholders, including future potential measures, such as advancing digital quality measurement, and revisions to the IRF-Patient Assessment Instrument (IRF-PAI) to reduce burden.

CMS is proposing an update to the SNF PPS payment rates by 2.8% and revisions to the SNF QRP and Value-Based Purchasing Program. Similar to the IRF proposed rule, CMS is proposing to remove the four data elements related to SDOH that were finalized in last year's rulemaking process. CMS also seeks input on several RFIs related to future measures in the SNF QRP.

ARN will be submitting comments on these proposed rules before the June 10 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.

Notice of Funding Opportunities

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

• Rehabilitation Research and Training Center (RRTC) on Employment Policy (HHS-2025-ACL-NIDILRR-RTEM-0125)
• NINR Areas of Emphasis for Research to Optimize Health and Advance Health for All (R01 Clinical Trial Optional) (PAR-22-230)
• NINR Areas of Emphasis for Research to Optimize Health and Advance Health for All (R21 Clinical Trial Optional) (PAR-22-231)
• Centers for Independent Living Competition – Kansas (HHS-2025-ACL-AOD-IL-0017)
• Leveraging Network Infrastructure to Conduct Innovative Research for Women, Children, Pregnant and Lactating Women, and Persons with Disabilities (UG3/UH3 - Clinical Trial Optional) (PAR-25-311)