Category: Nurse Advocacy

Regulatory Roundup

  

The American Nurses Association (ANA) plays a vital role in shaping federal healthcare policy through regulatory advocacy, particularly by engaging with the Centers for Medicare & Medicaid Services (CMS) during its annual rulemaking cycle. Each year, CMS proposes payment rules  to update the Medicare payment program, influencing quality reporting, practitioner reimbursement, and emerging healthcare priorities.  

These proposed rules typically have a 60-day comment period—allowing stakeholders to review the proposals and submit comments through regulations.gov. After the 60-day comment period closes, CMS reads and counts every comment to determine which proposals should be finalized or changed from the proposed rule and implement the policy in the next fiscal year.  

2026 Payment Rules 

In the 2026 cycle, ANA reviewed the proposed rules and determined which proposals impact nursing practice the most and submitted detailed comments to ensure the nursing profession’s voice is represented, including the role of Advanced Practice Registered Nurses (APRNs) and their scope of practice. 

A consistent theme across the proposed 2026 rules was the removal of quality metrics related to Social Determinants of Health (SDOH) and equity, replaced by new measures focused on well-being, nutrition, and related categories. Additionally, the role of AI, digital health and telehealth were also seen throughout the proposed 2026 rules. Finally, another widespread suggested change was the elimination of COVID-19 vaccination reporting requirements for healthcare personnel, reflecting the end of the public health emergency. ANA responded to the shift in quality metric reporting by advocating for the retention of SDOH metrics and emphasizing the importance of nurses in delivering person-centered care across all healthcare settings. ANA, across its comments, stressed the importance of evidence-based quality measures, workforce metrics like nursing turnover, and regulatory flexibility to support telehealth, safe staffing, and nurse-led care planning. 

ANA also submitted comments to the Administration’s Requests for Information (RFIs) on deregulation in healthcare and across the department of Health and Human Services as well as in the context of digital health. These comments reinforced the need to eliminate regulatory barriers that prevent APRNs from practicing to the full extent of their training and licensure.  

Across specific payment systems, ANA’s comments were tailored to the unique challenges and opportunities in each care setting: 

  • Physician Fee Schedule: ANA’s  comments focused on telehealth and AI flexibilities, reimbursement, the removal and addition of quality measures, and ensuring nurses are included in the implementation of new metrics. 
  • Hospital Outpatient Prospective Payment System:  ANA’s comments emphasized the role of nurses in coordinated care and urged CMS to support rural access, innovation, and transparency. Key issues included telehealth reimbursement, hospital price transparency, practitioner terminology, and supervision authority. 
  • Home Health  PPS: ANA’s comments opposed the removal of SDOH metrics and called for greater nurse involvement in developing quality measures. ANA also stressed the need to maintain nursing visibility in patient surveys and electronic health records, balance functional and outcome-based measures, and eliminate outdated COVID-19 vaccination metrics. 
  • Hospice Prospective Payment System: ANA’s comments supported allowing APRNs to conduct and sign hospice recertification attestations, called for immediate implementation of the Hospice Outcomes and Patient Evaluation assessment tool, and highlighted nurses’ role in applying quality metrics for patient-centered care. 
  • Inpatient Psychiatric Facility Prospective Payment System: ANA’s comments backed the removal of COVID-19 vaccination reporting given the end of the public health emergency but opposed eliminating SDOH measures. ANA emphasized nurses’ contributions to developing new quality metrics and advocated appropriate staffing to improve outcomes and retention. 
  • Inpatient Prospective Payment System: ANA’s comments urged CMS to remove regulatory barriers for APRNs, retain equity-focused quality measures, and engage nurses in shaping hospital quality programs. ANA also supported ending COVID-19 vaccination reporting mandates. 

Overall, ANA’s regulatory advocacy in the 2026 CMS rulemaking cycle focused on preserving and enhancing the visibility, authority, and impact of nurses in all healthcare settings and the preservation of SDOH data metrics.  

ANA consistently emphasized the need for evidence-based quality measures, the removal of administrative burdens like outdated COVID-19 vaccine reporting, and regulatory flexibility to empower nurses and improve patient outcomes. The ANA Policy and Government Affairs team continue to track all the payment rules as they are finalized.  

Removing Regulations, Removing Barriers to Nursing Practice

  

Since President Trump took office, we have seen an Administration-wide push to eliminate unnecessary regulations. Back in January, President Trump issued an Executive Order (EO), Unleashing Prosperity Through Deregulation, requiring agencies to get rid of ten existing regulations for every new regulation introduced. This builds on deregulatory efforts from President Trump’s first term, where agencies were asked to get rid of two regulations for every new regulation introduced—now at a 5x larger scale. The goal of this effort is to increase government efficiency and reduce the administrative burden for stakeholders. As part of complying with the EO, the Department of Health and Human Services (HHS) sought public feedback on which regulations to eliminate through a request for information (RFI) on a deregulatory plan to lower healthcare costs and empower healthcare providers.

ANA has long-identified persistent regulatory barriers that nurses face and welcomed the opportunity to provide comment to HHS. In ANA’s official response to the RFI, the association detailed how HHS’ deregulatory efforts can remove barriers to nursing practice and advance our policy priorities by action such as:

  • removing regulatory barriers to allow advanced practice registered nurses (APRNs) to practice at the top of their license,  
  • eliminating overly burdensome collaboration and supervision requirements,
  • removing “incident to” billing from Medicare reimbursement,
  • making COVID-19 telehealth flexibilities permanent,
  • and banning the use of non-compete agreements for nurses in Medicare and Medicaid facilities.

Notably, this RFI from HHS is not the first health-related deregulatory RFI of this Administration—in May, ANA responded to the Centers for Medicare & Medicaid Services’ (CMS’) RFI on deregulation. CMS continues to promote this RFI in its 2026 Medicare Hospital Outpatient Prospective Pay System and Physician Fee Schedule proposed rules. This signals that the deregulation efforts will remain a key priority for the Administration. ANA will continue to respond to opportunities to weigh in on deregulation efforts as we advocate for nurses and advance nursing priorities. 

Future Nurses, Present Advocates: A Nursing Student’s NSNA Convention Experience

  

I’ve always been drawn to the dual role of advocacy in nursing. On one hand, it means seeking to understand patients and standing up for their well-being at the bedside, and on the other, it involves using those firsthand experiences to influence healthcare systems and policies. That broader vision of nursing inspired me to attend the 73rd Annual National Student Nurses’ Association (NSNA) Convention in Seattle, WA. There, I had the unique opportunity to not only represent the University of Texas at Arlington as a delegate, but to also approach the four day event through the lens of a policy and ethics intern for the American Nurses Association (ANA).

The NSNA hosts a network of over 50,000 members to foster professional development opportunities for nursing students. Members automatically gain admission to the NSNA by joining their school or state chapter affiliates; for example, my membership dues for the Arlington Nursing Students’ Association included access to the Texas Student Nurses’ Association and the NSNA. At the convention, students attended focus sessions on topics ranging from climate change and public health to medical malpractice. Dozens of professional nursing organizations—including ANA—tabled at the Exhibit Hall, where students gained firsthand access to study tools, nurse advocacy groups, nursing school admissions resources, and hospital employers. Several students ran for NSNA officer positions and took advantage of the convention to platform their campaigns in time for elections.

As a first-time attendee, my favorite part of the convention was the House of Delegates business meetings, where delegates voted on resolutions to shape nursing education and practice. Resolution authors representing their state and local chapters brought their proposals to the floor, and delegates engaged in pro/con style debates to offer new perspectives on each topic. Some resolutions, such as increasing food label literacy and expanding code lavender in hospitals passed unanimously, while other topics like maintaining Diversity, Equity, Inclusion, Belonging, and Accessibility legislation and preserving fluoride in drinking water garnered longer disputes.

The sheer range of perspectives presented was fascinating to me because they proved that nurses represent an array of lived experiences. I quickly learned that these weren’t only nursing students—they were also patients, immigrants, entrepreneurs, and parents. For example, a student from Arizona proposed that school nurses ought to be pre-hospital and trauma certified to make schools safer in the event of mass casualties and natural disasters. She shared that as a mother, she created the resolution out of concern for her school-aged children, effectively bridging her roles as a parent, advocate, and future nurse.

This delegate’s resolution, among several others, informed me of issues I had never considered before stepping into the convention. We often picture “advocacy” as wielding a bullhorn at the picket line or speaking to elected officials. While these ideas can be true, there’s a quieter, lesser known side of advocacy that involves absorbing stories from the people we serve, and approaching each of their experiences with curiosity and humility. Interestingly, this practice closely mirrors what nurses are already trained to do with their patients; future nurses are building the skillsets to listen actively and compassionately, collaborate across differences, and  work toward shared solutions.

Spaces like the NSNA Convention show nursing students how far these skills can reach beyond the bedside. In a climate where less than 10 percent of nurses are estimated to be involved in professional organizations and advocacy efforts, the NSNA Convention offers future nurses the vital opportunity to remain engaged and to see the impact of their voices firsthand. Listening to each resolution made it clear how much work lies ahead of us—but it also left me inspired by the knowledge that, as a future nurse, I have the power to help advance the nursing profession and its policies.

The delegation clashed over different priorities at times, but they stood united in one idea: nurses should be heard, and they are qualified to enact change. Ryan Barrett, the newly-elected 2025-2026 NSNA President, captured this best in his acceptance speech:

“There’s an old saying in advocacy: ‘If you’re not at the table, you’re on the menu.’ But we have a bolder vision. We’re not just pulling up a chair – we’re building a bigger table. A table where every nursing student’s voice echoes through the halls and where decisions on the future of the nursing profession are made. A table where the future of healthcare is shaped by those who deliver it.”

To join the NSNA and learn about all the resources it offers to nursing students, check your school’s constituency status and review the organization’s membership brochure.