Did you know that many hospitals have special supervision requirements for their outpatient services – including nursing care? Special requirements for “direct” supervision by physicians and other health care providers particularly affect nursing services, observation units, and critical access hospitals (CAHs). ANA has advocated to rescind or improve these requirements, which can affect nurses’ ability to provide IV therapy, chemotherapy, and other nursing care in hospital outpatient and observation units. The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule maintaining the requirement, with minor changes.

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Recent decisions by CMS, the Centers for Medicare and Medicaid Services, have a direct and significant impact upon nursing practice and care, for RNs as well as APRNs. The proposed rule for Medicare Conditions of Participation is open for comments; the rule regarding ACOs is a final rule. The link to the Federal Register notice of each rule appears after each heading. ANA comments can be found on our website, Nursing World, at http://www.nursingworld.org/comments.

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On October 1, the Centers for Medicare & Medicaid Services (CMS) launched a new web-based resource called the “Plan Finder” to help beneficiaries and their families choose between drug and health plan options available in their area. “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs,” said CMS Administrator Donald M. Berwick, M.D.

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On July 8, Secretary Kathleen Sebelius of the Department of Health and Human Services announced three new initiatives to help states improve the quality and lower the cost of care for the approximately nine million Americans who are eligible for benefits under both Medicare and Medicaid programs. These individuals, known as “dual-eligibles,” include some of the sickest patients, and account for a significant and growing portion of health care costs — over $300 billion per year. A technical resource center will help states coordinate care, and demonstration projects are designed to improve care coordination and decrease hospital admissions of nursing home residents. The nursing home demonstration project calls for facilities to adopt improvements such as employing more nurse practitioners, and increasing evidence-based interventions to prevent falls, pressure ulcers, and other preventable conditions.

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With Congress mired indefinitely in political conflict over possible repeal of the Affordable Care Act, federal departments and agencies – as well as the states – are proceeding to carry out ACA’s blueprint for health reform according to schedule, as required by law. New regulatory rules, appointments, and programs are announced every day. Many of these will significantly impact patient care and access to health benefits – and thus nursing care and policy.

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Here is a wrap-up of recent actions affecting Medicare & Medicaid patients and providers by CMS, the Centers for Medicare & Medicaid Services. CMS has many excellent resources – including facts sheets, rules and regulations, and schedules for upcoming calls and public meetings — available on their website, www.cms.gov. CMS is taking a leading role in developing policies to implement the Affordable Care Act, in addition to its continuing responsibilities for administering Medicare programs for seniors and the disabled, as well as the federal portion of state Medicaid programs.

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