Health Policy Digest for January 2021

Happy new year, ARN members! We are pleased to present the January 2021 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.

Biden Administration Takes Shape
On January 20, Joseph R. Biden, Jr. was sworn in as the 46th President of the United States, with Kamala Harris becoming the first female Vice President. Over the coming weeks and months, the Biden-Harris Administration will continue to fill out its appointees and staff. Below, please see a short overview of the key nominees for positions overseeing health care policy.

• Xavier Becerra is the nominee for the Secretary of Health and Human Services. Becerra most recently served as the Attorney General of California, where he was been at the forefront of litigation defending the Affordable Care Act (ACA). He previously served 12 terms in the U.S. House of Representatives.
• Andrea Palm is the nominee for the Deputy Secretary of Health and Human Services. Palm previously served as the head of the Wisconsin Department of Health Services (DHS) under Gov. Tony Evers and leading the state's response to the COVID-19 pandemic. Prior to her role at the Wisconsin DHS, Palm worked in the U.S. Department of Health and Human Services (HHS) under President Barack Obama, serving as Acting Assistant Secretary for Legislation and Chief of Staff. She also worked for the White House Domestic Policy Council as a Senior Advisor during the implementation of the ACA.
• Dr. Rachel Levine is the nominee for Assistant Secretary for Health at HHS. Dr. Levine was previously the Secretary of Health for Pennsylvania and is a Professor of Pediatrics and Psychiatry at the Penn State College of Medicine. She was also the President of the Association of State and Territorial Health Officials (ASTHO).
• Dr. Vivek Murthy is the nominee for U.S. Surgeon General. Dr. Murthy previously served as Surgeon General during the Obama Administration and was a co-chair of the COVID-19 Advisory Board for the Biden-Harris Transition.
• Dr. Rochelle Walensky is the new Director of the Centers for Disease Control & Prevention (CDC). Dr. Walensky was previously the Chief of the Division of Infectious Diseases at Massachusetts General Hospital and a Professor of Medicine at Harvard Medical School.
• Dr. Marcella Nunez-Smith is the chair of President Biden's COVID-19 Equity Task Force. Dr. Nunez-Smith was previously an Associate professor of Medicine, Public Health, and Management and the Associate Dean for Health Equity Research at the Yale School of Medicine. She also was a co-chair of the COVID-19 Advisory Board for the Biden-Harris Transition. Dr. Nunez-Smith is expected to focus on the disparate impact of COVID-19 on people with disabilities, as well as racial and ethnic minorities, in her role as head of the Equity Task Force.
• Dr. Anthony Fauci will be a Chief Medical Advisor to the President on COVID-19. Dr. Fauci was most recently the Director of the National Institute of Allergy and Infectious Diseases (NIAID) and one of the key faces of the federal response to the COVID-19 pandemic. He has advised the last six U.S. presidents on a range of health and medical issues.

President Biden has not yet announced his nominees to lead other key agencies relevant to ARN and rehabilitation policy, including the Administrator of the Centers for Medicare and Medicaid Services (CMS). In the interim, long-time CMS staffer Liz Richter (previously the Deputy Director of the Center for Medicare) will serve as the Acting Administrator of CMS.

ARN Position Statement on Vaccinations of Rehabilitation Nurses and Nursing Staff
On January 15, the ARN Board of Directors issued a position statement supporting the availability of COVID-19 vaccinations for rehabilitation nurses and nursing staff. ARN strongly recommends that all rehabilitation nurses and nursing staff, including licensed practical nurses and nursing assistants, be vaccinated against COVID-19, while supporting the independent decision of RNs to understand and receive the vaccine. ARN also recommends that all rehabilitation nursing staff in skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs) be prioritized for vaccination due to the high rates of COVID-19 morbidity and mortality associated with resident populations.

Health Care Impact of 2021 Omnibus Bill
As noted in last month's issue of the ARN Health Policy Digest, Congress enacted the Consolidated Appropriations Act, 2021 in December 2020, which included a full Fiscal Year (FY) 2021 government funding package, approximately $900 billion in COVID-19 relief and economic stimulus policies, and a host of other health care-related provisions in a massive "omnibus" bill. Read a summary of the health care provisions in this bill prepared by ARN's health policy consultants, Powers Law.

HHS Finalizes Regulatory Sunset Rule
On January 8, HHS finalized a rule regarding the "sunset" or expiration of regulations that are more than ten years old if not re-approved by the Department. The majority of the rule was finalized as proposed, with an extension of the period to review regulations that are already more than ten years old and some additional categories of regulations that will be exempt from the sunset requirement. This rule is expected to have a dramatic impact on HHS operations and will require staff to review each regulation issued by HHS and confirm whether to keep the rule or allow it to expire. ARN joined comments by the Coalition to Preserve Rehabilitation (CPR) in December opposing this rule.

Since the rule is not effective until March, the Biden Administration has the opportunity to freeze any final rules not yet in effect and may put forth new rulemaking to roll back many of the "midnight" rules advanced in the final days of the Trump Administration. Read the final rule and a press release from HHS.

CMS Finalizes MCIT Rule
On January 12, CMS finalized a rule regarding a new coverage pathway for "breakthrough" technologies – the Medicare Coverage of Innovative Technology (MCIT) pathway. This would allow for simultaneous and immediate, but temporary, Medicare coverage of devices designated as "breakthrough" by the Food and Drug Administration (FDA). The rule also included a provision to codify the definition of "reasonable and necessary" when evaluating whether items and services qualify for Medicare coverage.

Read the final rule, a press release from CMS, and a fact sheet on the rule.

CMS Issues Final 2022 NBPP
On January 14, CMS finalized the 2022 Notice of Benefit and Payment Parameters (NBPP), which lays out payment policies and standards governing states, exchanges, issuers, and health care plans under the ACA marketplace. The agency finalized several provisions from the proposed rule, which was released on a significantly accelerated timetable before the Biden Administration took office. Among other policies, the 2022 NBPP will allow states to privatize enrollment websites operated by state exchanges ("direct enrollment"), reduce the fees paid by plan issuers to support ACA-related programs, and codify guidance from the Trump Administration allowing states to waive certain provisions of the ACA requirements to develop innovative coverage policies.

As with other recently finalized rules, the Biden Administration will have to decide whether to accept or work to roll back provisions in this rule. Read the final rule, a press release from CMS, and a fact sheet on the rule.

CMS Issues Final 2022 MA/Part D Rule
On January 15, CMS finalized the Medicare Advantage (MA) and Part D payment notice for Contract Year 2022. The rule will require Part D prescription drug plans to offer a real-time comparison tool for beneficiaries to understand cost and benefit information and expand the supplemental benefits that MA plans can offer to beneficiaries with chronic illnesses, among other policies.

Read the final rule, a press release from CMS, and a fact sheet on the rule.

If you haven't already, we recommend that you visit ARN's COVID-19 Resource page on the ARN website for the latest information and resources for rehabilitation nurses.

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