In a typical regulatory process:
Unless defined by law, the agency is under no mandate to issue the final rule within a specified time frame. Once the agency has completed its regulatory review, it publishes the final rule in the federal register. The information below provides you with the proposed rule, AANP’s submitted comments to that proposal and, where applicable, the final rule and AANP’s accomplishments in accordance with the agency's final regulation.
U.S. Department of Health and Human Services (HHS) Regulatory Burden Request for Information: As part of the initiative to reduce regulatory burdens in the health care system, HHS released a request for information for stakeholders to identify regulatory barriers that impact the health care marketplace. AANP took this opportunity to address the federal barriers related to NP practice that impede competition in the marketplace.
Cancellation of Cardiac Rehabilitation Incentive Payment Model Final Rule: CMS had approved a cardiac rehabilitation incentive payment model under the previous administration that would have allowed NPs participating in the model to order and supervise cardiac rehabilitation. The current administration proposed to cancel the model due to concerns about the model’s methodology and the mandatory nature of the model. AANP encouraged the administration to move forward with the model, but CMS finalized its proposal to cancel this payment model.
CMS Innovation Center Request for Information: CMS requested stakeholder feedback on the new direction of the Centers for Medicare and Medicaid Innovation (CMMI).
Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs for Contract Year 2019: This is an annual rule that revises the regulations for the Medicare Advantage and Prescription Drug Benefits Programs.
Medicare Advantage (MA) 2019 Rate Notice: This is an annual rule that updates the rates for the MA program and makes other program changes.
Clinical Laboratory Improvement Amendments (CLIA) Revisions to Personnel Regulations Request for Information: CMS requested feedback on revisions to the personnel regulations for CLIA.
Short-term, Limited-duration Insurance: CMS proposed to lengthen the maximum duration of a short-term, limited-duration insurance plans to 12 months.
2019 Medicare Fee Schedule Proposed Rule: This annual rule proposed changes to updates to the 2019 Medicare Fee Schedule, including proposed changes to evaluation and management (E/M) coding. Additionally, this proposed rule proposed updates to the 2019 Quality Payment Program, including an opt-in option for clinicians and a new low-volume threshold based off of Part B services billed per year.
2019 Medicare Shared Savings Program (MSSP) Proposed Rule: As you are aware, under the current structure of the MSSP, NPs are authorized accountable care organization (ACO) professionals. However, in order for an NP’s patient to be attributed to an ACO in the MSSP, the patient must receive at least one primary care service from a participating primary care physician in the ACO. In the latest MSSP Proposed Rule, HHS is proposing a pathway in which a patient can be assigned to an ACO without requiring one primary care visit from a primary care physician. Under this proposal, a patient can select an NP as their primary ACO clinician in the MSSP, and the patient will no longer need to see a primary care physician in order to be assigned to the ACO. CMS has directly requested feedback on this proposal.
FDA Opioid Policy Steering Committee Request for Comments: The FDA requested stakeholder feedback on suggestions and recommendations for how the FDA can best use its authority to combat the opioid crisis.
FDA Request for Information on Updating Existing Regulations: The FDA requested stakeholder feedback on FDA regulations that were outdated and could be updated, repealed or modified.
VA Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries: The VA is in the process of updating its disabilities rating schedules, and AANP commented on this proposed rule to ensure that language was not inserted into the schedule that would require a physician prescription for a bracing or assistance device. The final rule is still pending.
Authority of Health Care Providers to Practice Telehealth: This proposed rule would increase the ability of VA health care providers, including NPs, to provide telehealth to VA beneficiaries. AANP supported this proposed rule, and the VA adopted the proposals in its final rule.
Civilian Health and Medical Program of the Department of Veterans Affairs Proposed Rule: The VA issued a proposed rule to clarify and update the regulations for CHAMPVA.
Definition of "Employer" Under Section 3(5) of ERISA—Association Health Plans Proposed Rule: The DOL proposed to expand the definition of employer to broaden the criteria for when employers may join together to sponsor a health plan.
DOT Notification of Regulatory Review: The DOT is conducting a review of its existing regulations and has requested stakeholder feedback on outdated regulations that could be updated. AANP took this opportunity to comment on outdated regulatory language that prevents NPs from serving as medical examiners and medical review officers in various agencies under the DOT’s authority.
Promoting Telehealth in Rural America: The FCC requested comment in this proposed rule on how to maximize the ability of the Rural Health Care program to provide rural health care providers with access to telehealth services.
Quality Payment Program (QPP) 2018 Final Rule: The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) repealed the sustainable growth rate and established the QPP. Clinicians participating in the QPP will select one of two tracks: the Merit-based Incentive Payment System (MIPS) track or the Advanced Alternative Payment Models (AAPM) track. This final rule is an annual rule that updates the QPP regulations for the 2018 calendar year. This final rule also requested additional comments on certain topics, which AANP responded to in addition to our comments on the proposed rule.
Physician Fee Schedule 2018 Final Rule: This annual rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies, such as changes to the Medicare Shared Savings Program.
Home Health 2018 Final Rule: This is an annual rule that updates the payment rates for home health agencies. In this rule, CMS proposed implementing the Home Health Groupings Model beginning in 2019.
Medicare Hospital Outpatient Prospective Payment System (OPPS) Final Rule: This is an annual rule to update and revise the OPPS and Medicare ambulatory surgical center payment system. The proposed rule contained a provision, which AANP supported, to reinstate the nonenforcement of direct supervision instruction for outpatient therapeutic services in critical access hospitals and small rural hospitals. The provision was included in the final rule.