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Health Policy Digest for December 2020

 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.

Congress Passes Omnibus Spending and COVID Relief Bill
On December 21, the House of Representatives and the Senate passed a massive "omnibus" bill including full government funding for Fiscal Year (FY) 2021, a COVID-19 stimulus and relief package, and a broad swath of additional policies impacting health care and other fields. The package was signed into law by President Trump on December 27. ARN's consultants, the Powers Law Firm, will be preparing a detailed memo summarizing the major provisions in the bill in the coming days. Below are some of the key policies impacting rehabilitation nurses.

  • The omnibus includes a partial "fix" to the provider reimbursement cuts previously scheduled to go into effect on January 1, 2021, providing an approximate 3.75% increase to all services to mitigate cuts scheduled to impact, in particular, therapy services and physical medicine and rehabilitation physicians.
  • The omnibus provides for additional direct stimulus checks to most Americans. Individuals making less than $75,000 will receive $600, with gradual phase-outs for those with higher incomes.
  • Title VII Health Professions programs funding will receive an increase of 3%, or $15 million, over FY 2020, for a total of $489.5 million.
  • Title VIII Nursing programs funding will receive an increase of 2%, or $4.5 million, over FY 2020, for a total of $264.5 million.
  • The National Institute for Disability, Independent Living, and Rehabilitation Research (NIDILRR) will receive an increase of $1 million over FY 2020, for a total budget of $112.97 million.

Read the legislative text and summaries of the key provisions for appropriations, COVID relief, and other issues, prepared by the House Appropriations Committee. 

ARN Submits Comments on Extension of COVID-19 Regulatory Flexibilities
On December 28, ARN submitted comments in response to the Department of Health and Human Services' (HHS) Request for Information (RFI) on Regulatory Relief to Support Economic Recovery. Specifically, the RFI asked for feedback from health care stakeholders regarding which of the nearly 400 waivers and temporary flexibilities issued by the Department to respond to COVID-19 pandemic should be extended or made permanent. ARN's comments focused on the extension of the three-hour rule waiver and the 60 percent rule waiver, modification of the Inpatient Rehabilitation Facility (IRF) face-to-face requirement, expansion of telehealth under Medicare, and revision of the prior inpatient stay requirement for admission to a Skilled Nursing Facility (SNF). Read ARN's comments

CMS Issues Physician Fee Schedule Final Rule
On December 1, the Centers for Medicare and Medicaid Services (CMS) issued the final Calendar Year (CY) 2021 Physician Fee Schedule (PFS) rule, outlining payment policies for physicians and other health care providers. The rule finalized proposed increases to payment for Evaluation and Management (E/M) services, along with an associated cut to the conversion factor applied to all payments under the PFS; authorized additional services for provision via telehealth both temporarily and permanently past the end of the public health emergency; and allowed non-physician practitioners (including nurse practitioners) to supervise the performance of diagnostic tests; among other policies. Read the final rule, CMS' press release, and a fact sheet on the rule. ARN commented on the proposed rule in October via the Coalition to Preserve Rehabilitation – read the CPR comments

CMS Issues OPPS/ASC Final Rules
On December 2, CMS issued final rules for the Outpatient Prospective Payment System (OPPS) and payment policies for ASCs. Among other policies, the OPPS final rule begins the elimination of the Inpatient Only (IPO) list, allowing certain procedures to be paid by Medicare when performed outside of a hospital inpatient setting. The IPO will be completely phased out by CY 2024. Read the final rule, CMS' press release, and a fact sheet on the rule

CMS Floats IRF Review Choice Demonstration Project
On December 14, CMS announced it is seeking public comment on a new Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) services. The demonstration would offer IRF providers a choice between pre-claim or post-payment medical review of IRF admissions and services, intended to cut down on what CMS proposes are high rates of improper payments in the IRF system. The demonstration would begin in Alabama and be expanded to Pennsylvania, Texas, and California. Read the CMS announcement and proposed collection of information

CMS Announces Strategy to Enhance Hospital Capacity Amid COVID-19 Surge
On November 25, CMS outlined a new strategy to increase capacity in the health care system and provide care to patients outside a traditional hospital setting as COVID-19 hospitalizations rise across the country. This includes the Acute Hospital Care At Home program, which will provide additional regulatory flexibility for hospitals to treat patients in their homes, and flexibilities for ambulatory surgical centers (ASCs) to be temporarily certified as hospitals to provide inpatient care for longer periods than normally allowed. Read CMS' press release.

CPR Comments on HHS Regulatory Sunset Proposal
On December 4, the Coalition to Preserve Rehabilitation (CPR, of which ARN is a member) submitted comments on the Department of Health and Human Services' (HHS) proposal on Securing Updated and Necessary Statutory Evaluations Timely (SUNSET). The proposal would require regulations to expire after ten years if not re-approved by the Department. The CPR comments strongly opposed the proposal on the grounds that the proposed process is overly broad, the requirements on agency staff would be burdensome and would constrain regulatory work, and the blanket expiration of regulations could erode the regulatory framework that protects patients, especially those in need of rehabilitation. Read the CPR letter.

NCC Letter on FY 2021 Funding Requests
On November 20, the Nursing Community Coalition (NCC, of which ARN is a member) sent a letter to the House and Senate Appropriations Committees requesting at least $269.972 million in funding for Title VII Nursing Workforce and Development Programs, as outlined in the House appropriations bill released in July, and at least $177.976 million for the National Institute of Nursing Research (NINR), as outlined in the Senate appropriations bill released in November. The letter also reiterated previous NCC requests for additional supplemental funding to these programs. Read the NCC letter.

NCC Letter on COVID-19 Legislative Priorities
Also on November 20, the NCC sent a letter to Congressional leadership reinforcing the NCC's shared COVID-19 priorities to be included in any pandemic legislative relief package being prepared for consideration before the end of the 116th Congress. Read the NCC letter.

HPNEC Letter on FY 2021 Funding Requests
On November 24, the Health Professions and Nursing Education Coalition (HPNEC, of which ARN is a member), sent a letter to the House and Senate Appropriations Committees restating the coalition's recommendation of $790 million in funding for Title VII health professions and Title VIII nursing workforce development programs in Fiscal Year (FY) 2021. The letter also notes HPNEC's opposition to the Senate's proposed elimination of $15 million in funding for the Health Careers Opportunity Program (HCOP). Read the HPNEC letter.

ANA Letter on COVID-19 Legislation
On December 2, the American Nurses Association (ANA) sent a letter to Congressional leadership urging the passage of COVID-19 stimulus and relief legislation before the end of the 116th Congress. The letter outlined a number of key nursing priorities, including enhancing public health infrastructure, increasing the manufacture and distribution of medical supplies, and prioritizing nurses when developing allocation plans for COVID-19 vaccines. Read the ANA letter.

ANA Letter to Biden-Harris Transition Team
On November 13, the ANA sent a letter of congratulations to President-Elect Joe Biden and Vice President-Elect Kamala Harris on their election, outlining ways in which nurses can assist the transition team. The letter also detailed key priorities for the incoming Administration, including addressing health care disparities, improving the supply chain for Personal Protective Equipment (PPE), and equitably distributing COVID-19 vaccines. Read the ANA letter.

ANA/AMA/AHA Letter to Trump Administration on COVID-19 Information Sharing
On November 17, the ANA, along with the American Medical Association and the American Hospital Association, sent a letter to the Trump Administration urging cooperation and information sharing regarding COVID-19 with the incoming Biden Administration. On November 24, the General Services Administration (GSA) formally ascertained President-Elect Biden's victory, beginning the formal start of the transition process and allowing the transition team to engage with current Administration officials and staff. Read the ANA/AMA/AHA letter

If you haven't already, we recommend that you visit ARN's COVID Resource page on the ARN website for the latest information and resources for rehabilitation nurses.

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