ARN Health Policy Digest - June 2024

We are pleased to present the June 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.

Updates on FY 2025 Appropriations

It has been a busy June for House appropriators who have advanced multiple FY 2025 appropriations bills. During the week of June 10, the House Appropriations Committee successfully approved FY 2025 subcommittee bills covering Defense, Financial Services & General Government, the Legislative Branch, State-Foreign Operations and Homeland Security. Despite significant opposition from Democrats, who continue to argue that current non-defense discretionary spending levels are inadequate to meet critical needs and contradict the unwritten "side deal" from the 2023 debt-limit law, each bill passed and is headed to the House floor for consideration.

Up next, the House will be in recess during the week of June 17 and the Labor-HHS Appropriations Subcommittee is scheduled to mark up the Labor-HHS bill on June 27, with full Committee consideration scheduled for July 10. On the Senate side, the Senate Appropriations Committee will proceed with hearings examining FY 2025 budget requests, but markups will not begin until spending allocations have been set by Chairwoman Patty Murray (D-WA).

It's important to highlight that Congress has limited time to advance legislative efforts prior to leaving for the August recess. Following the July 4 recess, the House and Senate only have three working weeks in July before Congress leaves for August recess. When they return from August recess, we expect all eyes on a continuing resolution to fund the government through the November election. We'll keep ARN members updated as this work continues.

Congress Reintroduces the Improving Seniors' Timely Access to Care Act

On June 12, the Improving Seniors' Timely Access to Care Act (H.R.8702/S.4518) was officially reintroduced in both the House and Senate. The bill aims to streamline the prior authorization process for items and services under the Medicare Advantage (MA) program. Specifically, the bill would do the following:

Establish an electronic prior authorization (e-PA) process for MA plans including a standardization for transactions and clinical attachments.
Increase transparency around MA prior authorization requirements and its use.
Clarify the Centers for Medicare & Medicaid Services' (CMS) authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
Expand beneficiary protections to improve enrollee experiences and outcomes.
Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

The bill unanimously passed the House in the 117^th Congress but faced challenges due to its $16 billion Congressional Budget Office (CBO) score. Members of Congress worked to address CBO scoring issues by successfully pushing the CMS to implement major provisions of their bill. The reintroduced legislation builds off CMS' recently implemented prior authorization final rules and now has a CBO score of $0. ARN hopes to see the legislation cross the finish line and enacted into law before the end of this year! You can read the bill text and a section-by-section summary.

Nursing Shortage Impacting Staffing Mandate

Following CMS' final rule on Minimum Staffing Standards for Long-Term Care Facilities, several nursing home operators express concern over meeting the new staffing mandate due to the nursing shortage. The mandate, which requires 24/7 registered nurse presence and specific staffing ratios, faces opposition and a federal lawsuit, with facilities expressing concerns over finding sufficient staff amidst high costs and burnout exacerbated by the pandemic.

MedPAC Report Discusses Lowering IRF Payment Rates

The Medicare Payment Advisory Commission (MedPAC) released its congressionally mandated June 2024 Report to the Congress: Medicare and the Health Care Delivery System. This year's report included a chapter that considered ways to lower Medicare payment rates for select conditions in inpatient rehabilitation facilities. Specifically, the chapter explored alternative approaches to lower fee-for-service (FFS) payment rates for beneficiaries admitted to IRFs with select conditions, in lieu of an across-the-board reduction to IRF payment rates, to "better align payments with costs." It's important to note that the Commission has recommended since 2009 that the Congress reduce the aggregate level of FFS payments to IRFs. The Commission is concerned that Medicare's high payment rates encourage IRFs to treat cases that do not require this level of care and unnecessarily increase Medicare spending. Consequently, the Commission recommended several steps for Congress to minimize how frequently Medicare pays for inappropriate IRF stays, including directing CMS to (1) regularly evaluate the list of conditions that count toward compliance and the compliance threshold, (2) clarify existing coverage rules, (3) continue to educate providers about appropriate admissions and documentation, and (4) expand its monitoring and review of claims.

Save the Date: NINR Director's Lecture on Maternal Health

The National Institute of Nursing Research (NINR) will be hosting a Director's Lecture on maternal health on July 11 at 1:00 pm ET. The online lecture will feature Dr. Mahasin Mujahid, Professor at the School of Public Health, University of California at Berkley, who will present her work on the social and structural determinants of maternal health, health disparities, and risk reduction interventions to address the complex and growing morbidity and mortality concerns in maternal health. Please see here to register and for more information.

Notice of Funding Opportunities

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