ARN Health Policy Digest - June 2023

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.

Debt Ceiling Drama is Over, Budget Battles Continue

On June 3, President Joe Biden signed H.R. 3746, the Fiscal Responsibility Act of 2023, preventing what would have been the federal government's first-ever default. The bill, passed with bipartisan and bicameral support, raises the debt ceiling until 2025, and incorporates spending cuts. It establishes caps for discretionary spending in fiscal year (FY) 2024 and FY 2025, particularly for non-defense programs, allocating $703.65 billion and $710.69 billion respectively. Failure to pass all twelve spending bills by January 1 of the calendar year in FY 2024 and FY 2025 will result in a one percent cut in discretionary spending. The bill also rescinds nearly $28 billion in unobligated funding from COVID spending bills.

Since the country avoided defaulting on its debt, conservative House Republicans have made their displeasure clear—the budget caps included in the deal did not cut federal spending enough and they want to see FY 2024 appropriations rolled back to the FY 2022 level. House Appropriations Committee Chair Kay Granger (R-TX) responded by releasing a statement saying the debt ceiling deal set a ceiling for spending, not a floor for FY 2024 bills and announced plans to claw back $115 billion in spending. Last week the House Appropriations Committee set the total allocation for the Labor, Health and Human Services, Education and Related Agencies at $147.1 billion, which is an approximately 30 percent cut below the FY 2023 level. Given the grim prospects for health funding the House, all eyes are on the Senate where Chair Patty Murray (D-WA) and Vice Chair Susan Collins (R-ME) have announced plans to take up all 12 spending bills, which will adhere to the caps in the debt limit deal, before the August recess. The difference in the House and Senate appropriations levels could result in a government shutdown when the new fiscal year begins on October 1 unless a compromise can be found. 

Enter heading here...ARN Comments on CMS' IRF and SNF Proposed Rules

Earlier this month, ARN submitted comments on two annual proposed rules released by the Centers for Medicare and Medicaid Services (CMS). ARN provided input on the Fiscal Year (FY) 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Proposed Rule, including comments on CMS' updates to IRF PPS payment rates and IRF quality measure proposals. ARN also commented on the FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System Proposed Rule. In this proposed rule, ARN not only weighed in on the payment updates and quality payment proposals, but also the updates to the SNF Value Based Purchasing Program. ARN looks forward to seeing the final rules released later this summer.

Congress Weighs in on Prior Authorization​

A bipartisan and bicameral group of 233 legislators, led by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera (D-CA), and Larry Bucshon (R-IN), and Senators John Thune (R-SD), Sherrod Brown (D-OH), Roger Marshall, M.D. (R-KS), and Kyrsten Sinema (I-AZ) sent a letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra and CMS Administrator Chiquita Brooks LaSure calling on the agency to expeditiously approve a set of proposed rules to modernize and streamline the prior authorization process. Additionally, the members are pushing CMS to add provisions to the rule to make it align more with the Improving Seniors' Timely Access to Care Act, a bill that ARN endorsed in the 117^th Congress.

MedPAC Releases June 2023 Report​

The Medicare Payment Advisory Commission (MedPAC) published its annual June 2023 Report to the Congress: Medicare and the Health Care Delivery System. The report includes 10 chapters addressing issues including, but not limited to, telehealth, behavioral health, drug prices, and post-acute care. The press release and entire report are available for review.

Notices and Funding Opportunities

• Rehabilitation Engineering Research Centers (RERC) Program: RERC on Universal Access to Information and Communication Technology (HHS-2023-ACL-NIDILRR-REGE-0097)
• Rehabilitation Research and Training Center (RRTC) on Disability Statistics and Demographics (HHS-2023-ACL-NIDILRR-RTGE-0028)
• Department of Health and Human Services, Administration for Community Living
  International Exploration of Rehabilitation Length of Stay Following Spinal Cord Injury Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=346846
• Department of Health and Human Services, Administration for Community Living
  Improving Methods for Conducting Research with People with Cognitive Disabilities in Virtual Environments Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=346808
• Department of Health and Human Services, Administration for Community Living
  Scaling Up Evidence-Based Services to Promote Competitive Integrated Employment Among People with Disabilities Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=346847
• Department of Health and Human Services, Administration for Community Living
  Understanding the Experience and Outcomes of Students with Disabilities who have 504 Plans Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=347717
• Department of Health and Human Services, Administration for Community Living
  Projects for Translating the Findings and Products of Disability and Rehabilitation Research and Development into Practice Synopsis 2 https://www.grants.gov/web/grants/view-opportunity.html?oppId=346809
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Research and Training Center (RRTC) on Disability Statistics and Demographics Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342572
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Engineering Research Centers (RERC) Program: RERC on Universal Access to Information and Communication Technology Synopsis 2 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342592
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Research and Training Center (RRTC) on Community Living Policy Synopsis 1
  https://www.grants.gov/web/grants/view-opportunity.html?oppId=342609
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Engineering Research Centers (RERC) Program: RERC on Prosthetics and Orthotics Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342602
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Research and Training Center (RRTC) on Research and Capacity Building for Minority Entities Synopsis 2 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342606
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Research and Training Center (RRTC) on Health and Function Among People with Intellectual and Developmental Disabilities Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342612
• Department of Health and Human Services, Administration for Community Living
  Rehabilitation Research and Training Center (RRTC) on Employment Among People with Physical Disabilities Synopsis 1 https://www.grants.gov/web/grants/view-opportunity.html?oppId=342556
• Native American Research Centers for Health (NARCH) (S06 Clinical Trial Optional) (PAR-23-166)
• Notice of Intent to Publish Notice of Funding Opportunity Announcements for Down Syndrome Cohort Research Sites (DS-CRS) for the Down Syndrome Cohort Study Program (DS-CDP) across the lifespan for the INCLUDE Project (NOT-OD-23-134)
• Notice of Intent to Publish Notice of Funding Opportunity Announcements for a Down Syndrome Clinical Cohort Coordinating Center (DS-4C) for the INCLUDE Project (NOT-OD-23-135)
• Notice of Intent to Publish Notice of Funding Opportunity Announcements for a Federated Biobanking resource for the Down Syndrome Cohort Study Program (DS-CDP) across the lifespan for the INCLUDE Project (NOT-OD-23-136)
• Notice of Intent to Publish a Notice of Funding Opportunity for the HEAL Initiative: KIDS Acute Pain Clinical Trials (APCT) Program (U01 Clinical Trial Required) (NOT-HD-23-015)
• Notice of Intent to Publish a Notice of Funding Opportunity for the HEAL Initiative: HEAL KIDS (Knowledge, Innovation and Discovery Studies) Pain Program Resource and Data Center (U24 Clinical Trial Not Allowed) (NOT-HD-23-016)
• Request for Information: NIH Common Fund is Soliciting Ideas for NIH-wide Challenges and Opportunities (NOT-RM-23-013)
• Accelerating Behavioral and Social Science through Ontology Development and Use: Research Network Projects (U01 Clinical Trial Not Allowed) (PAR-23-182)
• Accelerating Behavioral and Social Science through Ontology Development and Use: Dissemination and Coordination Center (U24) Clinical Trial Not Allowed (PAR-23-181)