Implementation of the health insurance exchanges (Exchange), a key provision of the Affordable Care Act, is less than nine months away. The deadline for notifying the Department of Health & Human Services (HHS) as to the proposed design of a state health insurance exchange is history. Seventeen states plus the District of Columbia (DC) have received conditional approval from HHS to run their own Exchange. Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Utah, and Washington. If not planning to operate a state based exchange, states have until February 15th to notify HHS of the desire for a state-federal partnership. Arkansas and Delaware have already been conditionally approved for the partnership model as others wait to hear. Any states not having submitted a request to HHS for either of the two models will be subject to a federally run Exchange with the ability to amend their decision in the future. Regardless of the decision as to the type of Exchange, there remains allot of work yet to do by all involved parties.
The Medicare Physician Fee Schedule Final Rule, issued November 1, and effective January 1, 2013, could have a major impact for many RNs and APRNs, especially those working in primary care and care coordination. The Centers for Medicare & Medicaid Services (CMS) approved new CPT codes and payments for transitional care management and complex chronic care coordination. ANA represents the nursing profession for the CPT Editorial Panel and the RUC (Relative Value System Update Committee), and we helped develop and value these codes.
On January 1, 2013, new coding and reimbursement policies go into effect for many psychiatric/mental health services. Many services will be paid at higher levels.The new policies recognize the challenges of caring for patients with severe mental illness, multiple co-morbidities and complex medications, in community settings as well as hospitals and other inpatient facilities. his is great news for advanced practice registered nurses (APRNs), psychiatric registered nurses (RNs), and other mental health providers.
Election year or not, this time of year is always a busy time for ANA and the state nurses associations as they come together for the annual lobbyist meeting and the American Nurses Advocacy Institute (ANAI), both held in Washington, DC, just blocks from the Capitol. Rich discussions and attempts to predict upcoming legislative sessions are plentiful.
Payment issues often drive choices in health care. Consequently, a very influential policy maker in Washington is the bipartisan Medicare Payment Advisory Commission, or MedPAC. In March and June of each year, MedPAC reports to Congress on the state of the Medicare program, and recommends payment rates and policies for Medicare providers, including hospitals and advanced practice registered nurses (APRNs).
Recent changes to the “Conditions of Participation” (CoPs) for hospitals participating in Medicare and Medicaid will give nurses more flexibility in key areas — nursing care plans, standing orders, medication administration, infection control, and medical staff participation by advance practice registered nurses (APRNs). In the notice of final rule, the Centers for Medicare and Medicaid Services (CMS) recognized the contributions and leadership of registered and advance practice nurses, even quoting from ANA’s comments. CMS also decided to grant critical access hospitals (CAHs) more flexibility in how they operate. With the Joint Commission involved in ensuring hospitals comply with the CoPs, the guidelines can also have an effect beyond Medicare/Medicaid hospitals.