Health Care Policy & Legislation Updates
News from the DRRC
JUNE 2021—The Disability and Research Rehabilitation Coalition (DRRC) has shared two upcoming events that may be of interest to ACRM members.
Health Equity Webinar
The National Institute for Health Care Management (NIHCM) Foundation is holding a webinar on Achieving Health Equity for People with Disabilities During the Pandemic and Beyond on Monday, 28 June from 1:00 – 2:00 PM ET. The event is free and open to the public. REGISTER HERE TO ATTEND.
ICDR Stakeholder Meeting
This virtual meeting will share the current accomplishments and vision of the Interagency Committee on Disability Research (ICDR), as well as the future of its mission and activities. It will also provide an overview of the current state of research progress and identify future research priorities in four main topic areas:
- Assistive Technology & Universal Design
- Community Integration & Participation
- Employment & Education
- Health, Functioning & Wellness
Audience: The audience will include a wide range of ICDR stakeholders, federal interagency partners, researchers, practitioners, disability organizations and ICDR Committee members.
Registration: Space is limited. REGISTER HERE to reserve your spot and to receive instructions for joining the meeting. Registration closes 18 June.
A short prep call with the DRRC coordinators is scheduled on Tuesday, 22 June at 11:00 AM ET—anyone is welcome to join the meeting to strategize key issues to raise with ICDR.
DRRC FY 2022 Appropriations Requests to Senate and House
MAY 2021—The Disability & Rehabilitation Research Coalition (DRRC) submitted their FY 2022 appropriations request letters last week to the Senate and House Committees on Labor, Health and Human Services, Education, and Related Agencies. The DRRC recommended that Congress increase funding for NIDILLR by $10 million for a total of $122,970,000 in FY 2022 to respond to the COVID-19 pandemic and support existing needs. A dedicated budget line of $2 million was requested for the Interagency Committee on Disability Research (ICDR). Finally, the DRRC strongly supported the request to appropriate $5 million to fund the National Concussion Surveillance System to improve data collection capturing the extent of concussions in the United States. Read More >>
Dr. Anjali J. Forber-Pratt appointed NIDILRR Director
MAY 2021—After several years of Acting leadership, NIDILRR welcomes their newly appointed permanent director, Dr. Anjali J. Forber-Pratt. A two-time Paralympian and medalist in the sport of wheelchair racing, Dr. Forber-Pratt has dedicated her life to helping others recognize their potential. She began her research career in 2006 at Vanderbilt University where she served as principal investigator for research projects covering a range of disability issues, including training of special education teachers and experiences of students with disabilities at every education level. Today her primary area of expertise is disability identity development.
Dr. Forber-Pratt is pictured here with her service dog, Kolton. Read More >>
ITEM Coalition Comments on MCIT Interim Final Rule
APRIL 2021—The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition submitted comments last week on CMS’ Interim Final Rule on the Medicare Coverage of Innovative Technology (MCIT) pathway. The Coalition supports implementation of the MCIT pathway to expand access to new devices and technology for Medicare beneficiaries. The Coalition also specifically recommended that CMS develop an expedited Benefit Category Determination (BCD), coding, and payment determination process for MCIT-eligible devices, in order to ensure that beneficiaries are afforded timely access to these devices once approved by the Food and Drug Administration. Read More >>
CMS authorizes 24 new audiology and SLP codes for provision via telehealth
APRIL 2021—CMS announced that 24 audiology and speech language pathology codes will be newly authorized for provision via telehealth through the end of the COVID-19 PHE. These reflect nearly all of the codes the Coalition to Preserve Rehabilitation requested be added to the telehealth list. Follow the link below to the full list of codes now authorized for telehealth. Read More >>
Summary of key provisions of the American Rescue Plan Act
March 2021—On 11 March, President Joe Biden signed the American Rescue Plan Act of 2021, a $1.9 trillion COVID-19 relief and economic stimulus package that passed in the Senate by a simple majority vote under the budget reconciliation process. This package includes a wide range of additional funding for previously enacted COVID-19 public health and fiscal programs, including funds to improve testing, tracing, and vaccinations; expanded benefits for unemployed workers; direct payments to individuals making less than $75,000 annually; and aid to state and local governments. Follow the link below to review a memo summarizing key sections. Read More >>
Regulatory SUNSET Rule Delayed
March 2021—The Department of Health & Human Services (HHS) announced that they are delaying the regulatory SUNSET rule, which was finalized in the last days of the Trump Administration. As of now, the department is not rescinding the rule entirely, but may make further changes during the delay period. The rule would have required nearly all regulations from HHS to be substantively reviewed every 10 years and regulations would expire if not affirmatively approved by the department.
Some key points are listed below and you can read the complete notice in the Federal Register.
- The rule’s effective date is being delayed for one year (until 22 March 2022), allowing time for HHS to review and for a legal challenge to proceed (County of Santa Clara v. HHS).
- HHS now believes it is “likely” some regulations would expire without any additional administrative review due to the volume of regulations needing to be assessed, contrary to the Department’s assertion in the original final rule.
- HHS notes that the rule raises additional administrative law questions about whether regulations can be terminated without individual consideration and stakeholder comment.
- HHS also notes that the potential automatic expiration of rules and programs would create uncertainty and unpredictability in the health care industry.
Medicare Coverage of Innovative Technology (MCIT) rule delayed
March 2021—Last week, CMS formally announced the delay (until 15 May) of the effective date for the final Medicare Coverage of Innovative Technology (MCIT) rule, released in the last days of the Trump Administration. CMS has also opened a new 30-day public comment period until 17 April to address new issues relating to the rule, including:
- Operational issues regarding benefit category determinations and payment methodologies
- Potential overlap with provisions of the proposed DMEPOS rule
- New information regarding the amount of eligible devices (higher than expected)
- Need for more detail around the “reasonable and necessary” definition
DRRC recommends comprehensive research agenda to combat COVID-19 disparities
February 2021—The DRRC recently summarized its recommendations in a letter to Dr. Nunez-Smith and the COVID-19 Health Equity Task Force for improving the lives of Americans with disabilities by enhancing the federal commitment to disability, independent living, and rehabilitation research. In particular, this letter addressed:
- Critical COVID-19 Research on Disability, Independent Living, and Rehabilitation
- Collection of Demographic Data on COVID-19 Including Disability Status Data
- Support for COVID-Specific Disability and Rehabilitation Research at the Federal Level
Priorities for the Biden Administration
February 2021—On behalf of DRRC, Bobby Silverstein participated in a conference call this month between the disability and aging communities and ACL leadership. Alison Barkoff, Acting Administrator and Assistant Secretary for Aging, Administration for Community Living, described priorities for the Biden Administration, which included, among other things, the need for and importance of disability-related information and data to track and ensure meaningful and effective access to disability, independent living, and rehabilitation services and supports and equity.
After the formal presentation and during the Q and A period, Bobby urged the Administration to:
- expeditiously appoint a new permanent director of NIDILRR
- actively involve ICDR in collaborative effects to address the COVID pandemic
- recognize the critical importance of COVID-19 research on disability, independent living, and rehabilitation
- institutionalize the urgent need to collect demographic information and data on COVID-19, including disability status data
- support for COVID-specific disability and rehabilitation research at the Federal Level
Bobby also shared the fact that DRRC has submitted a letter to the Chair of the Biden-Harris COVID-19 Health Equity Task Force with a copy to Andy Imparato (disability rights advocate and member of the Task Force) highlighting action steps addressing these concerns.
Please let us know ASAP if you have any feedback or suggested comments on NINDS’ Draft Strategic Plan. DRRC will be circulating draft comments for review in the coming weeks.
Final FY 2021 Omnibus Summary
February 2021—The DRRC recently provided ACRM members a summary memo regarding the FY 2021 omnibus bill enacted by Congress in December. As in past years, this summary includes a searchable index of statements of congressional intent regarding key programs within the Labor, Health and Human Services, and Education appropriations bill. Members may also review the catalog of report language excerpts, and the spreadsheet with funding levels. Only excerpts that specify congressional intent and did not include references to report language that simply described a particular program were included.
Of note, the report accompanying the 2021 omnibus states that unless otherwise noted, the language set forth in the House bill passed in July 2020 carries the same weight as language included in the omnibus explanatory statement. Therefore, we have also included relevant report language from the House report in this document, unless those excerpts are duplicative of or contradicted by language in the omnibus bill.
Biden Administration Actions on COVID-19
January 2020—The Biden Administration has taken recent actions regarding the COVID-19 response that are particularly relevant to the ACRM Community. Please follow the links below for full details on these important actions:
Request for Feedback on Long-Term Impacts of COVID
December 2020—The Coalition to Preserve Rehabilitation (CPR), of which ACRM is a member, is seeking feedback from patients, providers, caregivers, and advocates regarding the long-term impacts of COVID-19 and the need for COVID rehabilitation. Please consider the two following requests and submit any feedback directly to Joe Nahra, CPR Coordinator, at Joseph.Nahra@PowersLaw.com by 31 December 2020. This input is critical for advancing the goal of preserving and enhancing access to rehabilitation needed to combat the long-term impacts of COVID-19. Specifically, they seek:
Access to Rehabilitation: Specific recommendations to increase access to COVID rehabilitation – think of barriers that you or your patients have encountered in accessing care for the long-term effects of COVID or policies you think should be in place to increase access.
Patient Stories: Patient and/or caregiver stories of the long-term impacts of COVID and/or your experience with COVID rehabilitation. We would like you to indicate to the Coalition your potential interest in sharing your stories now or in the future as opportunities arise to highlight this message with policymakers. We are looking for responses to the following questions, though we welcome additional information:
- What long-term impacts have you experienced from COVID-19 after being discharged from the hospital (or other setting of care)?
- What forms of rehabilitation have you participated in, for how long, and were they helpful in addressing your long-term symptoms?
- What barriers have you encountered in seeking rehabilitation to address your long-term symptoms?
*If submitting a patient/caregiver story, please indicate whether you are willing to be identified and share your story or prefer to share anonymously.
DRRC Presidential Transition Letter with research priorities
November 2020—Follow the “Read More” link below to review a letter sent to the Biden-Harris Presidential Team from the Disability Rehabilitation Research Coalition (DRRC), of which ACRM is a member. The letter outlines the DRRC’s priorities for disability and rehabilitation research in the next administration and provides a brief overview of the key priorities on which we have been active this year, with references to more detailed DRRC letters circulated over the year. Read More >>
Congratulations to Theresa Hayes Cruz
September 2020—As a member of the Disability and Rehabilitation Research Coalition (DRRC), ACRM congratulates Theresa Hayes Cruz, PhD on her recent appointment as the permanent Director of the National Center for Medical Rehabilitation Research (NCMRR). As a key leader in the federal government’s efforts to advance the science of disability, rehabilitation, and independent living, we look forward to continuing our work with Dr. Cruz in her new role and to deepening the DRRC’s longstanding relationship with the Center and other Institutes and Centers involved in rehabilitation science. We are delighted to welcome Dr. Cruz to the ACRM VIRTUAL Annual Conference, where she will participate in the Featured Session: Federal Funding Opportunities & Initiatives for Rehabilitation. Read More >>
Coalition to Preserve Rehabilitation comments on HH PPS proposed rule
September 2020—The ACRM Policy & Legislation Committee reports that the Coalition to Preserve Rehabilitation Steering Committee submitted comments on the CY 2021 Home Health Prospective Payment System (HH PPS) proposed rule. They focused on the observed impact so far of the Patient-Driven Groupings Model (PDGM), which was implemented beginning 1 January 2020. They reiterated past concerns about incentives within the new payment system that may lead to decreased access to therapy, and urged CMS to collect and publicly report robust and frequent data on therapy utilization, patient characteristics, and other factors in order to appropriately judge the impact of the PDGM on access. Read More >>
DRRC Urges Secretary Azar to Collect Disability Status Data in COVID-19 Reporting
May 2020—The Disability and Rehabilitation Research Coalition (DRRC) and 12 disability and rehabilitation stakeholder organizations urged the U.S. Department of Health and Human Services (HHS) Secretary, Alex M. Azar, II to ensure that the Centers for Disease Control and Prevention (CDC) and other program operating components within the Department collect and report data on demographic characteristics, de-identified and disaggregated by disability status, to better inform the COVID19 pandemic response. Standing in strong support of the 13 May letter on this issue from Senators Bob Casey and Elizabeth Warren and Representatives James Langevin and Ayanna Pressley, they agree that data should address Testing and diagnoses; Treatment and Outcomes. Read More >>
Updates from Capitol Hill
March 2020—Congress and the Trump Administration have taken several key steps to address the expanding public health crisis caused by the coronavirus, known as COVID-19, while at the same time trying to staunch the negative repercussions currently affecting the nation’s employment and financial markets. Members are invited to review a summary provided by ACRM attorneys on Capitol Hill including emergency spending bill enacted earlier this month to fight the epidemic, a brief description of a series of waivers issued by the Centers for Medicare and Medicaid Services (CMS), which grant greater flexibility in treating patients; and a link to new CMS requirements that limit visitors and communal activities in nursing homes. Read More >>
Trump’s Budget Proposal Substantially Cuts Medicare, Medicaid Funding
February 2020—President Trump released a budget proposal to fund the federal government for the next fiscal year (FY 2021). The proposal features broad cuts to domestic discretionary and mandatory spending (including substantial cuts to Medicare, Medicaid, and discretionary government programs, including those supporting disability, independent living, and rehabilitation research). The ACRM Policy & Legislation Committee advises members to review the summary memorandum of this budget proposal provided by the Disability and Rehabilitation Research Coalition (DRRC) for a fuller understanding of its potential impact. Please reference the FY 2021 Appropriations Spreadsheet. Read More >>
Huge Win for the Disability Community
December 2019—The House released text of its FY 2020 spending package, which is expected to be voted on as soon as tomorrow. H.R. 2293, the bill that protects manual CRT wheelchairs from competitive bidding, is included in the bill – Division N, Section 106. This is a huge win for the disability community. This bill will permanently exempt manual complex rehabilitation technology (CRT) wheelchair bases from competitive bidding, and suspends the competitive bidding rates for manual CRT wheelchair accessories for an 18-month period, beginning January 1, 2020 and lasting until June 31, 2021. The expectation is that the package should be signed by the president by the end of the week. Read More >>
Appropriations Package Reauthorizes PCORI For Ten Years
December 2019—At the time of publication, success is in sight for PCORI, as the FY2020 Appropriations package, H.R. 1865, released late today includes a provision to reauthorize PCORI through 30 September 2029. The 12 appropriations bills will be sent to the House floor in two separate packages or “minibuses” starting 17 December. PCORI reauthorization is in the second minibus to be considered. It is expected that after House passage, the minibuses will immediately go to the Senate for passage and then on to the White House for the President’s signature prior to midnight on Friday, 20 December.
Changes to PCORI’s statute include:
- Extension of the authorization to 2029 (i.e. 10 years more)
- Extension of the funding from PCOR health insurer fees
- Increased mandatory appropriations to offset elimination of the transfers from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund
- Addition of intellectual and developmental disabilities and maternal mortality as research priorities
- Consideration of the “full range of outcomes data” to include the “potential burdens and economic impacts of the utilization of medical treatments, items, and services on different stakeholders and decision-makers respectively. These potential burdens and economic impacts include medical out-of-pocket costs, including health plan benefit and formulary design, non-medical costs to the patient and family, including caregiving, effects on future costs of care, workplace productivity and absenteeism, and healthcare utilization.”
- The option for GAO to add 2 more seats to the Board of Governors for payers/purchasers
- Shift the selection of the Methodology Committee by the Board of Governors, instead of the GAO
- Expanded scope of GAO oversight in its reports, including AHRQ collaboration with stakeholders related to dissemination activities
FY 2019 funding for rehabilitation highest since 2013
December 2019—Last week at the National Advisory Board on Medical Rehabilitation Research (NABMRR) meeting, the Council Liaison discussed the ongoing search for a new permanent director of NCMRR. Dr. Joe Bonner, Program Director at NCMRR, also provided an overview of an upcoming conference and associated research efforts around physical activity for mobility-impaired individuals, March 30-31 at NIH. Dr. Theresa Cruz, Acting Director of NCMRR, also reported that across NIH, FY 2019 funding for the rehabilitation category tops an estimated $680 million, the largest number since categorical tracking was revised in 2013. NCMRR’s funding for 2019 reached $73 million, of which approximately 81% ($58) went directly to research and related projects. Read More >>
CMS Releases Final Rule on Discharge Planning
October 2019—On behalf of the ACRM Policy & Legislation Committee, members are invited to review a summary of the final rule on discharge planning, released on 30 September by the Centers for Medicare and Medicaid Services (CMS). This follows the proposed rule originally issued in November 2015 and updates the discharge planning requirements for hospitals, critical access hospitals, and home health agencies in the Medicare Conditions of Participation. Read More >>
Medicare Payment Advisory Commission Discusses a Value Incentive Program for Post-Acute Care
September 2019—The ACRM Policy & Legislation Committee would like to share a memo summarizing the presentation and discussion on a Value Incentive Program (VIP) for post-acute care at the September meeting of the Medicare Payment Advisory Commission (MedPAC). The presentation slides are available here. Read More >>
CPR: Final Comments on Home Health Rule and Steering Committee Letters
Proposed rule to update Medicare Home Health Prospective Payment System is open for comments
August 2019—The ACRM Policy and Legislature Committee would like to draw your attention to a proposed rule published by the Centers for Medicare and Medicaid Services (CMS) to update the Medicare home health prospective payment system (HH PPS) for calendar year 2020. Your comments on the proposed rule are encouraged and are due by 5:00 PM EDT on 9 September. Please follow the link below to review a summary of the key updates to the HH PPS and analysis of the potential implications of these updates for providers of home health services and patients receiving home health care under the new payment system. Read More >>
Congressional leaders announced a budget and debt deal
23 July 2019—Robert Silverstein, lobbyist and principal of Powers Pyles Sutter & Verville PC reported to the DRRC and the ACRM Policy and Legislation Committee that a budget and debt deal was announced Monday by the White House and congressional leaders. The debt will be raised through July 2021 and the budget deal would be for FY’20 and 21. In FY’20, federal agencies overall would get a nearly 4 percent increase over the FY’19 levels with $738 billion for defense spending and $632 billion for non-defense. In FY’21 those amounts would be $740.5 billion for defense and $634.5 billion for non-defense. The agreement also includes language that the 12 appropriations bills won’t include any policy riders or changes to transfer authority, such as the administration’s ability to move money to Trump’s border wall project, unless there is bipartisan agreement on those issues. The House is expected to pass the legislation on Thursday. Passage in the Senate is expected next week. Sources have stated that Senate markups of individual appropriations bills will begin shortly after they return from the August break.
Azar v. Allina case impacts Medicare payment for services
July 2019—The United States Supreme Court issued a 7-1 decision last month in Azar v. Allina Health Services, which will have far-reaching implications for the validity of the Centers for Medicare and Medicaid Services’ (CMS) sub-regulatory guidance governing Medicare payments to providers of rehabilitative services and devices. The Court held that CMS must use notice-and-comment rulemaking before issuing guidance that establishes or changes a substantive legal standard governing Medicare payment for services. Read More >>
Nondiscrimination proposed rule
June 2019—The ACRM Policy and Legislation Committee would like to share with members an important memo on the administration’s proposed rule for replacing the current implementation of Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, disability, age, and sex. Comments on the Proposed Rule are due 60 days after publication in the Federal Register. Read More >>
Proposed Rule on Inpatient Rehabilitation Facility Prospective Payment System
On 24 April 2019, the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published a proposed rule in the Federal Register updating the prospective payment rates for inpatient rehabilitation hospitals and units (IRFs) and proposing other changes in regulations for federal fiscal year (FY) 2020. With certain notable exceptions, most of the proposed regulatory changes described are highly technical and are of most relevance to IRFs and their operations. CMS has also published a fact sheet for the rule. Comments on the proposed rule are due 17 June 17 2019 by 5:00 PM EDT. Read More >>
Summary and Excerpts from FY 2020 House Labor, HHS, Education Appropriations Bill
May 2019—On 8 May, the House Appropriations Committee reported out the FY 2020 Appropriations bill for Labor, Health and Human Services (HHS), Education (ED), and related agencies. The bill is accompanied by a written report that includes statements of congressional intent and charts documenting appropriated levels for specific programs. Members are encouraged to review excerpts from the bill and the Appropriations Chart here. Follow the “Read More” link for a summary memo to the DRRC. Read More >>
Analysis of ACL/NIDILRR Reorganization Notice
May 2019—On May 9, 2019, the Administration for Community Living published an updated Statement of Organization, Functions, and Delegations of Authority in the Federal Register. Follow the link to review a comparison of the newly released notice with the original statement of organization published in 2015, when NIDILRR was moved under the umbrella of ACL. No substantive or policy changes to NIDILRR’s structure or organization have been made, and only minor retitling, technical and conforming changes were made to the 2015 statement. Read More >>
Update on the MedPAC Episode-Based Payment Model for Post-Acute Care
May 2019—The March meeting of the Medicare Payment Advisory Commission (MedPAC) continued the discussion of implementing a unified payment system for post-acute care (PAC) using an episode-based payment model. To review the key points of that meeting, please follow the link to a memo summary. It presents an overview of the stay-based and episode-based models. It also includes recommendations presented by MedPAC for transitioning to a PAC unified payment system. The important take-away of this debate is that MedPAC Commissioners appear to be taking a pause in their deliberation of designing a unified PAC payment system. Read More >>
ICDR Government-Wide Strategic Plan – 2018-2021
March 2019—The Workforce Innovation and Opportunity Act (WIOA) (Public Law 113-128) included a requirement for the ICDR to develop a comprehensive government-wide strategic plan for disability, independent living, and rehabilitation research. Coordinated by the ICDR, the strategic plan is the culmination of an extensive effort to engage WIOA-defined stakeholders – policymakers, representatives from other Federal agencies conducting relevant research, individuals with disabilities, organizations representing individuals with disabilities, researchers, and providers – in order to methodologically produce a document that reflects their priorities and capitalizes on potential interagency synergies. Follow the link to review the final report. Read More >>
Highlights of the NIDILRR 2018-2023 Long Range Plan
January 2019—The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) released its 2018-2023 Long Range Plan (LRP). The LRP presents a comprehensive agenda that will advance the vital work being done in applied disability, independent living, and rehabilitation research and development. The LRP emphasizes consumer relevance and scientific rigor and will enable NIDILRR to further its mission of enhancing the ability of people with disabilities to achieve inclusion and integration into society. Highlights include:
- Role and location of NIDILRR
- Overarching factors influencing the research agenda
- Outcome domains
- Cross-cutting research activities
- Stages of research and development
- Activities that promote the quality and use of sponsored research
New Opioid Bill encourages research on non-opioid pain treatment
October 2018—On Wednesday, 24 October, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act, into law. This bi-partisan bill was widely supported and includes many of the House- and Senate-passed provisions aimed at combating the opioid crisis, reforming regulations to increase access to addiction treatments, encouraging research on non-opioid pain treatments, and increasing law enforcement activities to stop the importation of synthetic opioids into the U.S. The ACRM Policy and Legislation Committee encourages members to review this memorandum that breaks down the key provisions of the bill and potential grant opportunities included. Read More >>
Senate Appropriations Committee Calls for Increased NIDILRR Funding
June 2018 – The ACRM Policy and Legislation Committee is pleased to inform members that the recent Senate Appropriations Committee report accompanying the Labor-HHS-Education appropriations bill included $109M for NIDILRR, which is a $4M increase over the FY2018 omnibus bill. In addition, “the committee continues to support NIDILRR in ACL and does not transfer the program or activities to NIH.” The report also specifies that “the committee provides NIDILRR $4M to fund competitive assistive technology research grants that help individuals with disabilities, with a particular emphasis on seniors, maintain or improve independence.
The Final Rule: Implications for Rehabilitative Services and Devices
17 April 2018 – The Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published in the Federal Register its Notice of Benefit and Payment Parameters final rule for 2019. The Final Rule will be effective on June 18, 2018. Follow the link to review an analysis of the Final Rule’s implications for rehabilitative services and devices, including the States’ role in defining essential health benefits and qualified health plan certification, as well as the costs of coverage and network adequacy. Read More >>
Alarmingly Low Funding Levels in Trump’s 2019 Budget Proposal
26 February 2018 – President Trump’s Fiscal Year 2019 budget proposal released on February 12, 2018 contains a large number of alarmingly low funding levels and structural changes to key disability and rehabilitation programs. However, it is difficult to analyze with precision the true impact of these proposals for three reasons outlined in a memorandum to ACRM and members of the Disability and Research Rehabilitation Coalition (DRRC). The memo summarizes some of the proposed funding amounts for rehabilitation and disability research programs, as well as for related disability programs run by the Administration for Community Living (ACL). Read More >>
Congress Passed Comprehensive Budget Agreement and Funded Government Through 23 March
On 9 February, Congress passed a comprehensive two-year budget agreement including a number of significant Medicare policies known as “Medicare extenders” as well as related health policies, and temporarily extended federal funding through 23 March 2018. Read the memorandum to ACRM members prepared by Powers Pyles Sutter & Verville PC for a summary of the bill. Read More >>
DRRC Meeting with NCMRR Director, Alison Cernich
5 December 2017 — The 13 December 2017 all-member meeting of the Disability and Research Rehabilitation Coalition (DRRC) will be a special one and we encourage ACRM members to participate. We are happy to announce that Dr. Alison Cernich, Director of the National Center for Medical Rehabilitation Research (NCMRR) at the NIH, will be joining us. Dr. Cernich will report on NCMRR’s rehabilitation research portfolio analysis, a project she has led for the past year. She will also report on progress and accomplishments at NIH and share highlights from her Dec. 4 presentation at the NCMRR Advisory Board meeting. We encourage you to join us for what promises to be an enlightening conversation on NCMRR’s work. We also ask that you please share this invitation with your organization’s research leaders and ask them to participate as well. Details for the Call WHEN: Wednesday, 13 December 2017 from 4:45 to 5:45 PM EST WHERE: Call in number: +1.712.451.0440 ACCESS CODE: 669370#
Senate Health Care Reform Effort & Possible Next Steps
26 September 2017—Senate Republicans decided not to vote on the Graham-Cassidy health care reform legislation to repeal and replace the Affordable Care Act (ACA). They had hoped to advance their legislation prior to the September 30 deadline for the Senate to pass health care reform legislation using the Fiscal Year 2017 budget reconciliation procedure, which would allow Republicans to pass the bill with a simple majority of 51 votes. Unable to secure enough votes to guarantee the bill’s passage, Senate Republicans opted not to bring the bill to the Senate floor. Read More >>
MedPAC Meeting: Encouraging Medicare beneficiaries to use higher-quality post-acute care providers
On 7 September, the Medicare Payment Advisory Commission (MedPAC), an independent legislative branch agency that provides Congress with analysis and policy advice on the Medicare program, held a meeting that included the session, Encouraging Medicare beneficiaries to use higher-quality post-acute care providers. Follow the link to review a memorandum on this meeting. Read More >>
Senate FY 2018 Federal Appropriations Levels for Your Review
The ACRM Policy and Legislation Committee invites your review of federal appropriations levels across a number of health, education, and labor priorities related to the federal budget items impacting many members. Follow the link to view a chart describing the difference between the Senate FY 2018 Appropriations Committee legislation and previous funding proposals and final amounts. To make the document easier to print, we have hidden a few of the historical columns (from 2013-2016), which you can “unhide” to expand and compare across a longer time frame. Read More >>
Hurricane Harvey Regulatory Relief Memo
7 September 2017—In response to Hurricane Harvey, the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and private insurers are offering regulatory relief to health care providers to ensure that individuals affected by the storm can access the care and services they need. Shortly after the storm began, HHS Secretary Tom Price declared a public health emergency in Texas and Louisiana. Secretary Price also authorized Social Security Act (SSA) waivers for Texas and Louisiana allowing CMS to reduce the regulatory burden on providers that serve Medicare, Medicaid and State Children’s Health Insurance Program (CHIP) beneficiaries. Review the Hurricane Harvey Regulatory Relief Memo for information and resources related to regulatory relief for health care providers and facilities in areas affected by Hurricane Harvey, particularly for providers that serve Medicare beneficiaries and people with disabilities. Read More >>
Final Rule Announced on Inpatient Prospective Payment System
On 3 August 2017, the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS) published the final rule in the Federal Register updating the prospective payment rates for inpatient rehabilitation hospitals and units (IRFs) for federal fiscal year (FY) 2018. This rule refines the ICD-10-CM list and the 60 Percent Rule presumptive methodology, and changes the IRF quality reporting program (QRP), among other things. Keep reading to review the highlights of the final rule and how CMS responded to comments from rehabilitation stakeholders. Read More >>
DRRC Appropriations Request and Update
4 August 2017— Last week, members of the DRRC met with Senate Appropriations Subcommittee on Labor-HHS-Ed staff and advocated for DRRC’s FY 2018 Appropriations priorities. Staff encouraged continued advocacy and outreach on these priorities. To that end, the ACRM Policy & Legislation Committee asks members to send the revised letter to Senate Appropriations Subcommittee on Labor-HHS-Ed member personal office staff in support of DRRC’s efforts. Please reference the Senate Staffers spreadsheet for contacts regarding DRRC’s priorities, as well as this sample message. Senate Appropriations Committee staff are actively working on the Labor-HHS-Ed bill, with a possible markup in early September, so it is imperative to support DRRC’s coalition efforts with your outreach to the Senate as soon as possible.
Impact on Health Care of Trump’s FY2018 Budget Proposal
26 May 2017—Last week, President Trump released his FY 2018 Budget. According to A New Foundation for American Greatness, a document prepared by the Office of Management and Budget (OMB), the Budget includes:
- $3.6 trillion in spending reductions over 10 years;
- $54 billion increase in defense spending in 2018 which is fully offset by $54 billion in reductions to non-defense pro-grams; and
- A plan that would reduce non-defense budget authority by two percent each year, to reach approximately $385 billion in reduced spending by 2027, or just over 1.2 % of gross domestic product (GDP).
Synopsis of the proposed budget Referenced Appropriations Chart
DRRC Meeting with NIH Leadership
23 May 2017—Representatives of several DRRC member organizations and Powers Law staff met with NIH officials at the NIH campus to discuss federal medical rehabilitation and disability research and the implementation of recently-passed legislation. The group also sought feedback and input from the NIH staff on specific NIH research developments as well as the implementation of Section 2040 of the 21st Century Cures Act (PL 114-255) known as the Enhancing the Stature, Visibility and Coordination of Medical Rehabilitation Research at NIH Act of 2016. Read More >>
Proposed Rule on Skilled Nursing Facility Prospective Payment System
4 May 2017—The Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register to revise the payment rates used under the prospective payment system for skilled nursing facilities (SNF) for fiscal year 2018. In an effort to continue to shift Medicare payments from volume to value, CMS also proposes additional policies and measures for the implementation of the Skilled Nursing Facility Value-Based Purchasing Program and the Skilled Nursing Facility Quality Reporting Program as well as an update on the SNF Payment Models Research project among other things. Your comments on the proposed rule are encouraged and due 26 June. Read More >>
The House GOP Affordable Care Act Repeal and Replacement Legislation
6 March 2017—The House Committee on Ways and Means and the House Committee on Energy and Commerce released legislation to repeal and replace the Patient Protection and Affordable Care Act (ACA). The House bill, called the American Health Care Act (AHCA), would significantly impact the individual and small group markets for health care coverage, with many of its sections repealing or significantly altering key components of the ACA. Follow the link for a summary of current law, contrasted with the proposals made in the AHCA and analysis of the bill’s key provisions and impact. The following memorandum offers a summary of current law, contrasted with the proposals made in the AHCA, followed by analysis of the bill’s key provisions, impact, and associated commentary. Read More >>
NIH Research Plan on Rehabilitation Released
15 September 2016—The National Center for Medical Rehabilitation Research (NCMRR) Director, Alison Cernich announced the release of the NIH Research Plan on Rehabilitation. Per the NICHD’s website, “This 5-year plan lays out priorities in medical rehabilitation research that will guide NIH support for rehabilitation medicine and will benefit individuals with temporary or chronic limitations in physical, cognitive, or sensory function that require rehabilitation.” This long-anticipated update coincides nicely with DRRC legislative work to advance S.800/H.R. 1631, legislation intended to enhance the stature and visibility of medical rehabilitation research at the NIH. Read More >>
Helping Hospitals Improve Patient Care Act (H.R.5273)
On 7 June 2016, the full House of Representatives passed the Helping Hospitals Improve Patient Car Act (H.R. 5273) via voice vote. The bipartisan legislation’s main objective is to advance hospital and Medicare payment reforms, among other changes. One of the most signicant provisions of the legislation provides relief related to Medicare payments for certain hospital outpatient departments (HOPDs). Read More >>
Summary of Hearing on Concussions in Youth Sports
May 2016—Following an initial roundtable discussion in March, the House Energy & Commerce Oversight & Investigations Subcommittee held a hearing earlier this month to examine concussions and head trauma in youth sports. The hearing focused primarily on prevention and protection of young athletes from brain trauma, as well as next steps in developing evidence-based policies. Even though more than 30 million children annually participate in organized sports, there is a lack of substantial awareness, prevention, and research related to head trauma and injuries among child and adolescent athletes. Read More >>
ACRM Members Call to Action: Critical Legislation Needs Co-Sponsors
On 19 March 2015, companion bipartisan bills (S. 800; H.R. 1469) were introduced to enhance the stature and visibility of medical rehabilitation research at NIH. DRRC has been working with members of Congress and NIH for years to craft this bill and enthusiastically supports these companion bills. They send a powerful message that our Nation can and must improve the quality of life of persons with disabilities and chronic conditions by enhancing medical rehabilitation research at NIH and, by so doing, improve the provision of rehabilitation services and devices. We urge you to contact your members of Congress in person when they are in the district, asking them to co-sponsor this critical legislation. Summary of the Bills Section by Section Analysis of the Bills Talking Points for Bills Template for Letter to Senators Template for Letter to House of Representatives
Priority Proposed for RRTC on Self-Directed Care to Promote Wellness for Individuals with Serious Mental Illness
The Administrator of the Administration for Community Living proposes a priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). This notice proposes a priority for an RRTC on Self-Directed Care to Promote Recovery, Health, and Wellness for Individuals with Serious Mental Illness. We take this action to focus research attention on an area of national need. We intend this priority to contribute to improved employment for individuals with serious mental illness (SMI) and co-occurring conditions. Comments must be received before 27 March 2015. Read More
Policy and Legislation Committee Offers Draft Wording for Review
On 22 July 2014, President Obama signed into law the Workforce Innovation and Opportunity Act (WIOA). The legislation includes significant changes to Title II of the Rehabilitation Act pertaining to the National Institute on Disability and Rehabilitation Research (NIDRR) and the Interagency Committee on Disability Research (ICDR), including amendments previously proposed by ACRM and others. A draft ACRM statement applauding Congressional action that made these changes is available for review and comment. Responses to any questions will be announced in eNews. Review Draft ACRM Statement Submit Comments
Congressional Leaders Announced Bipartisan/Bicameral Agreement Reauthorizing the Workforce Investment Act and Rehabilitation Act
On May 21, 2014 congressional leaders announced a bipartisan/bicameral agreement reauthorizing the Workforce Investment Act and the Rehabilitation Act. The bill number is H.R. 803 and the short title of the bill is the Workforce Innovation and Opportunity Act. View the bill, a section-by-section analysis prepared by congressional staff, and a one-page summary here. The following documents may also be of interest to ACRM members. The NIDRR Reauthorization Agreement summarizes the key changes to Title II of the Rehabilitation Act (Research and Training). The Redline of Title II Amendments compares the language in the bill to current law by indicating deleted language by using “strike-through” and by indicating new language by using bold and underline. The Senate is expected to act within a month, followed by the House. The President has indicated he will sign the bill. You may contact Robert “Bobby” Silverstein, Principal of Powers, Pyles, Sutter and Verville, PC with questions, direct: 202.872.6754.
DOD Request for Information: Ongoing Blast Injury Prevention Standards Recommendation (BIPSR) Process
February 2014—The BIPSR Process is currently focused on Human Lower Extremities (LE) Blast Injury Prevention Standards. The LE includes: lower limb, femur, knee, tibia, ankle (talus), foot and heel (calcaneus). The BIPSR Process injury types of interest are Fracture, Vascular Injury, Nerve Injury, Muscular Injury, Ligament and Tendon Injury, Traumatic amputation, and Dermal Burns. The BIPSR Process identified a need to define injury criteria and test methods to establish thresholds for protective systems designed to protect the military service members’ lower extremities from all blast injury categories and types in their respective operational environments. Read More
Status Update on the Convention on the Rights of Persons with Disabilities (CRPD) in the U. S. Congress
January 2014—The negotiations on the Convention on the Rights of Persons with Disabilities (CRPD) are currently at a stand-still in Congress. The U.S. Senate Committee on Foreign Relations last held a hearing on the matter on Thursday, 21 November 2013. During the hearing, testimony as given by Secretary of State John Kerry; Frances W. West, Worldwide Director, Human Ability & Accessibility Center; C. Boyden Gray, Former White House Counsel and Ambassador Read More
DRRC Commends Senators Kirk and Johnson for Bipartisan Introduction of S. 1027
July 1, 2013—Washington, DC: A large coalition of rehabilitation, disability, research, and provider organizations endorsed federal legislation intended to improve, coordinate and enhance rehabilitation research at the National Institutes of Health (NIH) to address the needs of people with injuries, illnesses, disabilities and chronic conditions. The Disability and Rehabilitation Research Coalition (DRRC) commended Senator Mark Kirk (R-IL) and Senator Tim Johnson (D-SD) for their bipartisan introduction of S. 1027, the Kirk/Johnson Rehabilitation Improvement Act, to spotlight the importance of advancing rehabilitation research at NIH and across other federal agencies. Read More.
Analysis of the President’s Budget (April 25, 2013)
On 10 April 2013, President Obama released his FY 2014 budget, two months after the official deadline by which the President is legally obligated to offer a spending proposal for the next fiscal year. His budget totals $3.77 trillion for 2014 and includes $580 billion in tax increases and over $1 trillion in spending cuts over the next ten years to achieve a total of $1.8 trillion of additional deficit reduction. While the President’s proposal brings the deficit down to 1.7% of the Gross Domestic Product (GDP) by 2023, it does not eliminate the annual deficit entirely. Read More
House Bill Would Eliminate Agency
Act locally to defend research funding. Now is the time to reach out to your Representatives and tell them that health services research, and the Agency for Health Care Research and Quality, must be protected.
- Summary of FY 2012 Appropriations and Applicable Report Language (PDF)
- Senate Committee Report No. 112-84 (Sept 22, 2011) (PDF)
- Departments of Labor, Health and Human Services, Education, and Related Agencies FY 2012 Appropriation Bill
ACRM Comments on AHRQ Draft Report, February 2012 (PDF)
On February 6, 2012, ACRM submitted comments on the Agency for Healthcare Research and Quality draft report, Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury. ACRM comments address concerns that the report reveals:
- Inadequate understanding of TBI post-acute rehabilitation;
- Deficiencies in the methodology;
- Insufficient consideration of the unintended consequences of paper on individuals with TBI and their families;
- Lack of recognition of the fiscal implications of the recommendations calling for a comprehensive research agenda; and
- Lack of summary comments.
House Democrats Introduce WIA and Rehab Reauthorization Bill (PDF)
By Robert “Bobby” Silverstein, Principal Powers, Pyles, Sutter & Verville PC
MARCH 21, 2012 – Yesterday, the House Democrats introduced the Workforce Investment Act of 2012. The provisions relating to NIDRR and disability and rehabilitation research are virtually identical to the provisions in the bipartisan Senate bill marked up last year. The Senate bill includes many of the recommendations made by DRRC. The House bill includes what is referred to as “cut and bite” amendments, which means that the bill amends current law by striking certain language and inserting other language. If you have not memorized current law, it is virtually impossible to figure out what is being proposed. To facilitate understanding of what’s in the bill, please review the red-line version of Senate draft (changes reflected in current law). There is no red-line version of the House Democrats bill. Below are the major categories of changes included in the House Democrats bill:
- Reaffirms the focus of NIDRR on the research domains of employment, community participation (independent living), and health and function as well as assistive technology and disability demographics.
- Promotes the implementation of evidence-based practices and emphasize the importance of knowledge translation and new methods of sharing and disseminating information.
- Expands the list of designated members of the ICDR.
- Directs ICDR to host a disability and rehabilitation research summit that will establish a strategic plan for disability and rehabilitation research conducted by federal agencies.