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Heath Policy Digest – December 2021

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 Averts Medicare Cuts & Raises Debt Ceiling

On December 10, the President signed S.610, the Protecting Medicare and American Farmers from Sequester Cuts Act, which includes policies to mitigate the 9.75 percent cut to Medicare payments that was scheduled for January 1, 2022. Of the planned 9.75 percent Medicare cut, physicians will only experience a 0.75 percent decrease on January 1. An additional 2 percent cut will be phased in during the year, meaning that Congress averted 7 percent of the total scheduled reductions. S.610 also included a provision that allowed Senate Democrats to bypass the filibuster and vote to raise the debt ceiling with only a simple majority. The provision allowed Congress to pass a bill on December 15 raising the federal debt ceiling by $2.5 trillion.

CR Deal Sidesteps Shutdown

With less than a day to spare before a looming government shutdown on December 3, the Senate passed and President Biden signed into law a continuing resolution (CR) that will keep the federal government open through February 18, 2022. The House approved the stopgap funding measure on December 2 by a party-line vote of 221-212, with Rep. Adam Kinzinger (R-IL) the sole GOP aye vote. Although several conservative senators briefly raised the possibility of a government shutdown during negotiations on an amendment that would block implementation of the OSHA vaccination standard for large employers, the measure ultimately cleared the Senate in a bipartisan 69-28 vote on December 2. The funding patch will extend federal agency operations at fiscal year 2021 levels with exceptions for certain programs, including $7 billion in aid to refugees from Afghanistan.

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!

Build Back Better Lands in Senate 

Following House passage of the Build Back Better Act on November 19, the sweeping reconciliation package has been taken up by the Senate, and Majority Leader Chuck Schumer (D-NY) has pushed his colleagues to pass the legislation before Christmas. The Senate Finance Committee unveiled its portion of the reconciliation bill on December 11, including language that would eliminate House-passed proposals to cut Medicaid Disproportionate Share Hospital (DSH) payments in states that have not expanded Medicaid eligibility, and to require minimum staffing levels in nursing facilities.

House and Senate Democrats had reached an agreement to close the Medicaid gap in non-expansion states, resulting in House language that would cut Medicaid DSH pay and uncompensated care pools in those states. However, several hospital groups opposed the DSH cuts, and urged legislators in November to remove minimum staffing ratio provisions and a requirement for facilities to have registered nurses available 24 hours a day. The Senate draft does not include the staffing requirements, but it preserves a $50 million allocation for HHS to regularly study appropriate minimum staffing ratios for nursing homes. The draft would also create an $800 million grant to support improved staffing in certain long-term care facilities. Medicare advocates have called on Congress to preserve the minimum staffing requirements, arguing that quality of care and patient outcomes improve with consistent safe staffing levels.

Courts Stay CMS Rule 

Federal judges in Missouri and Louisiana have issued preliminary injunctions to temporarily stay enforcement of the Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccination rule for healthcare facility workers, prompting the agency to announce that it will pause implementation of the rule while the separate legal challenges proceed. On November 29, 2021, the United States District Court for the Eastern District of Missouri issued an injunction preventing CMS from enforcing the vaccine mandate in ten plaintiff states; on November 30, the United States District Court for the Western District of Louisiana issued a similar injunction covering all remaining states. Both the Missouri and Louisiana court orders heavily cited a November 12 decision from the Fifth Circuit Court that ordered a temporary stay of the Occupational Safety and Health Administration (OSHA) Emergency Temporary Standard (ETS) requiring private employers with 100 or more employees to mandate vaccination or regular diagnostic testing. Now that a de facto nationwide stay of the CMS vaccination rule is in effect, providers covered under the rule will have more time to come into compliance by ensuring staff are fully vaccinated or have an appropriate exemption. The Biden administration has filed appeals to lift the injunctions, although the exact timeline for the two cases to be heard and resolved is not yet clear.

PAC Waivers Relieve Pandemic Hospital Crunch 

A new blog from Health Affairs examines changes in referral patterns for COVID-19 patients from short-term acute care hospitals (STACHs) to post-acute care (PAC) settings as a result of waivers passed in the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act). Separate waivers covering long-term care hospitals (LTCH), inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), and home health agencies were finalized through the CARES act and CMS rulemaking, effectively allowing Medicare PAC providers to help alleviate surges in patient volume occurring in STACHs that threatened to overwhelm hospital capacity. In combination, these waivers led to rapid changes to pre-pandemic post-discharge referral trends: relative to Medicare beneficiaries without COVID-19, beneficiaries with COVID-19 were more than twice as likely to be discharged from a STACH to an LTCH and 66 percent more likely to be discharged to an SNF in 2020.

To allow LTCHs greater flexibility to admit patients, CMS issued a blanket waiver to exclude patient stays from the 25-day average length of stay requirement, enabling LTCHs to accept COVID-19 patients discharged from STACHs sooner. Congress also waived the site-neutral payment requirements and the 50 percent rule, allowing LTCHs to receive maximum reimbursement for admitted COVID-19 patients. For skilled nursing facilities, CMS waived the requirement that patients must have a three-day qualifying stay to be eligible for Medicare reimbursement. More than 15 percent of SNF stays in 2020 were covered by the three-day stay waiver. However, 2020 also saw a 25 percent decrease in SNF Medicare fee-for-service stays and a 5 percent decrease in SNF Medicare Advantage stays.

U.S. Access Board to Host Event on Equity in Healthcare for People with Disabilities 

The U.S. Access Board will host a virtual public event on equity in healthcare for people with disabilities on January 12 from 2:30 – 4:00 p.m. (ET). The event will feature presentations on standards and resources related to healthcare accessibility, including inclusive medical equipment, healthcare facility design, information technology, and communication devices and systems. Members of the public will be able to pose questions during the event. To register for the event, click here.

NCC Support Health Workforce Investments 

On December 2, fifty-six health organizations representing the Nursing Community Coalition (NCC) signed a joint letter to Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY), urging the inclusion of several public health provisions in the forthcoming Build Back Better reconciliation package. The signatories called on Congress to invest $500 to assist nursing students, retain a diverse faculty, modernize nursing education infrastructure, and expand clinical education opportunities to prepare nursing students for their transition into the health workforce. In addition, the group advocated for a $500 million investment in the Health Resources and Services Administration (HRSA) Nurse Corps scholarship and loan repayment programs, to help educate more nurses and Advanced Practice Registered Nurses (APRNs). The letter also urged lawmakers to include several key provisions of the Black Maternal Health Momnibus Act of 2021 (H.R. 959): $170 million to expand and diversify the maternal and perinatal nursing workforce, $100 million in Maternal Mental Health Equity grant programs; $85 million for education and training at health professions schools on climate change-related health risks including the risks to pregnant, lactating, and postpartum individuals, and $50 million for antidiscrimination and bias training.

NCC Submit Appropriations Request 

Sixty health organizations representing the NCC joined a November 19 letter to Senate Appropriations Committee Chair Patrick Leahy (D-VT), Ranking Member Richard Shelby (R-AL), House Appropriations Committee Chair Rosa DeLauro (D-CT) and Ranking Member Kay Granger (R-TX), requesting fiscal year 2022 appropriations for nursing research and workforce development. The signatories urged appropriators to sustain the funding levels included in the House-passed minibus of at least $314.472 million for Title VIII Nursing Workforce Development Programs. Citing a Bureau of Labor Statistics (BLS) study which estimated that demand for RNs will increase 9 percent by the year 2030 – equivalent to 276,800 full-time nursing positions – and that demand for most APRNs will grow by 45 percent over the same period, the letter outlined the urgent need to support the nationwide nursing workforce amidst the ongoing COVID-19 pandemic. The letter also requests at least $200.782 million for the National Institute of Nursing Research (NINR) to invest in research on reducing chronic illness, improving end of life care, and addressing the social determinants of health.

HRSA Nurse Corps Loan Repayment Program Now Open

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