CMS Recognizes RNs’ Role Beyond the Bedside


On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published the Omnibus Burden Reduction Final Rule. This rule aims to reduce unnecessary burdens for America’s health care providers by allowing them to focus on their patients. It does so by removing Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other health care providers.

In the Final Rule, CMS finalizes a proposal to revise the Medicare Conditions of Participation (CoPs) for nursing services. It will remove the term “bedside” from the requirement that states, “there must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.” ANA applauds CMS’ recognition that RNs’ scope of practice extends far beyond bedside care in the inpatient setting and that RNs perform a wide range of duties within their scope of practice. ANA also applauds CMS’ recognition that RNs care for patients in many settings, including inpatient, outpatient, and ambulatory care settings.

One such area in which RNs play a crucial role is care coordination and transitions of care. ANA has long advocated for policymakers and other health care stakeholders to recognize and expand the role of RNs in this role. ANA’s official position statement on care coordination states that, “Patient-centered care coordination is a core professional standard and competency for all registered nursing practice. Based on a partnership guided by the health care consumer’s and family’s needs and preferences, the registered nurse is integral to patient care quality, satisfaction, and the effective and efficient use of health care resources. Registered nurses are qualified and educated for the role of care coordination, especially with high risk and vulnerable populations.”

While CMS’ recognizes that RNs practice in a far wider array of settings than just direct care nursing, CMS and Congress still have a long way to go to integrate RNs within their full scope of practice. Some of the ways ANA will continue to advocate for these changes include:

  • Inserting provider neutral language and correct valuation of RN care through the Current Procedural Terminology (CPT) and Relative-Value Scale Update Committee (RUC) processes;
  • Advocating for APRNs to certify Home Health and Hospice services; and
  • Securing adequate nursing education funding to ensure a robust future nursing workforce.

ANA will continue to vigorously promote RNs’ essential role in all health care settings – not just direct care – and to advocate for RNs at all levels to be able to practice to the full scope of their education and clinical training.

Title VIII Legislation Passes House, Advances to Senate Floor


At the end of October, there were 7,679 bills introduced in the U.S. House of Representatives and the U.S. Senate.

With so many pieces of important legislation constantly in front of lawmakers and staff, it makes the fact that H.R. 728, the Nursing Workforce Reauthorization Act, was passed unanimously in the House that much more exciting.

As you may recall, nurses lobbied their members of Congress during ANA’s Hill Day in June to urge their lawmakers to cosponsor this legislation. With your tireless advocacy, you can now say your work on Title VIII is completed in the House.

Additionally, on the other side of the Capitol, the Senate has been working just as hard on Title VIII. During the same week of House passage, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on S. 1399, the Nursing Workforce Reauthorization Act. We are pleased to report the legislation successfully went through the committee process and the next step is for a vote on the Senate floor.

With all eyes on the Senate, we ask you to reach out to your Senators and ask them to consider cosponsoring S. 1399. If they are already a cosponsor, ask them to talk to Senate Leadership to bring Title VIII for a vote this year.

While this week has been focused on Title VIII reauthorization, we are continuing to advocate for additional priorities such as the Home Health Planning Improvement Act (S. 296/H.R. 2150) and the Workplace Violence Prevention for Health Care and Social Service Workers Act (S. 851/ H.R. 1309), and additional important pieces of legislation.

Executive Order for Medicare Accelerates APRN Reforms and CMS Delivers


Last week’s Capitol Beat offered a 10,000-foot review of the Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors. This week, we take a deeper dive and connect the dots with ANA advocacy and a new success story expanding scope for advance practice registered nurses (APRNs) in Medicare.

Among other provisions, the Executive Order directs the federal Medicare agency to remove certain billing rules that can get in the way of providers caring for their patients. The initiative specifically targets Medicare practice rules that are more stringent than state laws. Medicare must propose new rules within a year’s time. This is welcome news for many APRNs participating in Medicare, who are subject to an array of confusing federal rules that keep them from practicing at the top of their profession in caring for Medicare beneficiaries.

ANA has long advocated for administrative reforms to lift separate Medicare practice restrictions on APRNs, who are subject to state licensing authorities where they practice. Most recently, in a letter to Medicare officials on September 24, 2019, ANA emphasized that federal payment rules applied to APRNs should not have the effect of restricting patient access and choice, and that Medicare beneficiaries are increasingly relying on APRNs for primary care. We also cautioned that federal restrictions on APRN practice can have systemic consequences, especially in rural, underserved, and appointment shortage areas, where new approaches are sorely needed to improve access and care experience.  

We are therefore excited to see signs in the Executive Order that nurses’ voices are being heard when it comes to health care reform. ANA and our members look forward to engaging with Medicare in the months ahead to identify some of the most troublesome barriers to APRN practice.

It is also encouraging to see that Medicare is already taking small steps to dismantle barriers to APRN care. The Centers for Medicare and Medicaid (CMS), starting next year, will allow nurse practitioners (NPs) in the state of Maryland to certify when their patients need home health care. This is a significant waiver of current law which requires an NP to bring in a physician, even when they are qualified under state practice authority to make such a decision.

The home health certification waiver in Maryland relates to a larger pilot program, which is testing a new payment system for Medicare in that state. Because of this pilot, CMS is able to authorize changes to existing law that are limited to the Maryland pilot. An act of Congress will be required to change the rules for the rest of the country. ANA supports the bipartisan Home Health Care Planning Improvement Act (H.R. 2150 / S. 296), which will allow NPs, clinical nurse specialists (CNSs), and certified nurse midwives (CNMs) to order home health care services without physician approval.

There is much work to be done to craft appropriate policies that expand access to APRN care and reward APRNs for the high-quality care they provide. ANA acknowledges and applauds the commitment of federal partners who are working with nurses to bring about the best possible results for our members and their patients.