2023 Regulatory Advocacy Roundup


Over the past year, ANA has been the voice of nursing in a diverse array of regulatory issues. ANA’s regulatory engagements, though sometimes overlooked, are an important part of our advocacy on behalf of more than 5 million nurses in the U.S. Not surprisingly, the main focus of advocacy is the federal Department of Health and Human Services (HHS) and its subagency, the Centers for Medicare and Medicaid Services (CMS). However, ANA engages other HHS subagencies, such as the Food and Drug Administration (FDA), and government agencies including the Veterans Affairs Administration (VA), Department of Labor (DOL), and the Federal Trade Commission (FTC) as well.

In 2023, nurse advocacy recorded real progress at the federal policy and program administration level: 

  • CMS is changing the way they refer to various types of health care providers. Instead of using limiting language in regulatory publications and guidance documents, e.g., referring to physicians, advanced practice registered nurses (APRN), physician’s assistants, or any other providers by name, CMS is using the more generic term of practitioner, unless restricted by statute. CMS’ definition of practitioner specifically includes any clinician (including APRNs) that is eligible to bill for a particular service. This change is of enormous importance as it signals CMS’ intention to recognize APRN care, as it does physician care, to the extent of its regulatory authority. 
  • CMS is also implementing provisions of the Balance Budget Act (BBA) and allowing nurse practitioners (NPs) to bill for cardiac and pulmonary rehabilitation services. These services are within an NPs scope of practice, which Congress realized when the legislation passed. CMS is now implementing this legislation, which took effect on January 1, 2024.  
  • CMS is strengthening the Medicare Diabetes Prevention Program (MDPP), which ANA supports. Specifically, CMS is extending telehealth flexibilities for the MDPP for another four years and is re-aligning payments. The MDPP program presents opportunities for nurses to show their value in providing patient-centered education and health promotion to beneficiaries at risk of developing diabetes.  
  • Also in 2023, CMS released a long-awaited proposal to establish minimum staffing requirements in nursing facilities. The final rule is still pending; however, the proposed rule broke new ground in recognizing the role of RNs in safe staffing and patient well-being. ANA will advocate for a robust final rule, which could go a long way toward improving work environments in long-term care. 
  • CMS finalized adoption of a long-term care quality measure that APRNs can leverage to show their value to operators of skilled nursing facilities (SNFs) that opt to be considered for value-based payment. The Long-Stay Hospitalization Measure is aimed at improving facility-based care, specifically to reduce hospitalization for long-stay residents. APRN care in nursing facilities has a demonstrated positive impact on this metric. While this measure does not take effect until 2027, the lead time gives nurse advocates a head start to educate SNFs about this payment incentive and how nurses can help them be rewarded for results. 
  • The VA continues to move forward with their proposal to nationalize standards of practice for non-physicians. This has been a long process, and the VA has so far not proposed standards for the two covered nursing specialties—RNs and certified registered nurse anesthetists (CRNAs). Other APRNs already have standards that were codified in 2016. ANA has taken part in VA listening sessions on the proposed standards, and while there has been strong opposition to some of the standards, the RN standard has not garnered the same attention. 
  • ANA saw progress on workplace violence prevention at the DOL in its subagency, the Occupational Safety and Health Administration (OSHA). This year OSHA finally made a first step forward in creating a Workplace Violence Prevention for Health Care and Social Assistance Standard. In May 2023, OSHA conducted a Small Business Review of a proposed standard. ANA submitted comments during this review, emphasizing that nurses across the country need and deserve a set of standards tailored to their risks on the job. We continue watching OSHA to ensure they follow through with completing this standard as soon as possible. 
  • ANA members submitted hundreds of letters to OSHA on their COVID-19 final rule. Members across the country submitted letters to OSHA urging them to release their final COVID-19 in Healthcare Settings Rule. This rule was weakened in December 2021 and nurses deserve the fullest respiratory protections at work. ANA continues to press OSHA to release this final rule.
  • Another agency which heard from ANA’s regulatory staff in 2023 is the FTC. The FTC has proposed to ban non-compete agreements in the employment sector generally. The proposal has not moved forward, but ANA’s voice was heard, and staff were quoted in publications about the proposed rule. 

Always looking forward, ANA encourages all nurses, RNs, and APRNs to register for their individual National Provider Identifier (NPI). ANA knows how hard nurses work, and now is the time for payment systems to fully recognize the value of nursing. Currently, the impact of registered nurses is hidden behind physician expenses or other service charges. By registering for an NPI, we can push systems to extract nursing services from the data and demonstrate the critical role of nurses in patient care. For more information, visit our NPI webpage. ANA also encourages all APRNs to apply for an NPI. Many APRNs bill through their employer, and while this is a perfectly acceptable way for their care to be reimbursed, it might limit future opportunities for the APRN. Additionally, obtaining an NPI does not require one to bill using it, as one may continue to bill through their employer, and would allow an APRN to open their own practice as Medicare and most private payers require an NPI for reimbursement. 

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