Every year, ACEP’s Public Affairs team takes a deep look at legislative issues affecting emergency physicians to evaluate progress made on key priorities. After analyzing what was accomplished over the preceding year, it takes a detailed look at the new congressional landscape. For example, the 117th Congress marks a shift to a slim Democratic majority in the U.S. Senate after years of Republican majority under the Trump administration. The team takes those factors into account when planning its advocacy strategy. ACEP’s annual legislative and regulatory priorities are reviewed by ACEP’s Federal Government Affairs Committee and then presented for approval to the ACEP Board of Directors during its annual January meeting.

As 2020 demonstrated, strategic planning cannot account for all contingencies, and no one anticipated the unexpected pivot to the COVID-19 pandemic response that occurred in early 2020. Though COVID-19 dominated much of ACEP’s advocacy efforts, the year closed out with a frenzy of year-end legislation that addressed other important issues, including surprise billing, pain management, Medicare reimbursement, and more. 

Let’s take a look at what was accomplished during the 116th Congress and what ACEP plans to focus its advocacy efforts on in the years ahead.

Key Accomplishments During the 116th Congress 

When emergency physicians found themselves at the front lines of the pandemic, ACEP’s advocacy work shifted to focus on the critical federal resources needed to address a multitude of concerns around personal protective equipmet (PPE), testing, physician mental health, vaccinations, and other vital issues. Included in COVID-19 legislation that passed in 2020 were provisions that:

• Ensured full coverage by insurers of testing for and diagnosis of COVID-19
• Provided the Centers for Medicare & Medicaid Services with the flexibility to allow for payment of emergency services via telehealth 
• Suspended Medicare sequestration
• Created a $100 billion Provider Relief Fund for which physician groups were eligible
• Provided additional federal liability protections for volunteer health care professionals during the COVID-19 emergency response
• Provided $22.4 billion for state testing, tracing, and COVID-19 mitigation programs
• Provided $20 billion for the Biomedical Advanced Research and Development Authority to procure vaccines and therapeutics; provided nearly $9 billion to the Centers for Disease Control and Prevention and states for vaccine distribution; provided $3.25 billion for reinforcement of Strategic National Stockpile; and authorized a national campaign to increase awareness and knowledge of vaccine safety and effectiveness
• Provided $4.25 billion for Substance Abuse and Mental Health Services Administration mental health and substance use disorder programs

Surprise Billing

ACEP has been working for years on behalf of emergency physicians and their patients to ensure that Congress enacts a fair and transparent solution to the issue of surprise medical billing (SMB). SMB legislation rose to the surface again at the end of 2020 and was an important provision in the year-end legislative package. Details included: 

• Equalizing in-network and out-of-network deductibles for emergency care
• Requiring deductibles to be printed on insurance cards
• Authorizing a Government Accountability Office study on network adequacy
• Requiring a 30-day response from insurers to claims
• Establishing an independent dispute resolution (IDR) (ie, arbitration) process with:
  • No minimum dollar threshold
  • All factors presented to arbiter considered with equal weight
  • Consideration of charges and public payer reimbursements prohibited
  • 90-day cooling-off period following IDR determination
• Providing provisions to improve transparency and support state all-payer claims databases

Medicare Reimbursement

Did you ride the Medicare reimbursement roller coaster with us in 2020? The numbers went up and down quite a bit. Finally, with the passage of a major omnibus bill at the close of the year, emergency medicine was spared from drastic reimbursement cuts. In fact, many emergency physicians may see an increase in Medicare reimbursement in 2021. 

• Based on an additional $3 billion for the Medicare Physician Fee Schedule (a 3.75 percent increase) and a three-year moratorium on the implementation of a new add-on code for complex office visits (G2211), emergency physicians will see, at worst, a small reduction in Medicare reimbursements and (depending on the services they deliver) may see an overall increase. Prior to year-end legislation negotitions, emergency physicians were facing a scheduled 6 percent cut to Medicare reimbursements.
  • Medicare sequestration suspension was extended for an additional three months (to March 31, 2021), preventing the 2 percent cut in Medicare reimbursements. (Medicare sequester cuts were part of a 2011 deal known as the Budget Control Act that has reduced Medicare reimbursements to health care workers by 2 percent across the board since 2013.)

Pain Management, Rural Hospitals, and More

The 2020 year-end legislative packages also addressed several important issues within emergency medicine: 

• Enacted the Easy MAT for Opioid Addiction Act (HR 2281/HR 8900/PL 116-215), which allows practitioners in the emergency department to dispense up to a three-day supply of “narcotic drugs” to an individual at one time for purposes of relieving acute withdrawal symptoms
• Passed the REACH Act, which permits community and rural hospitals to voluntarily convert to a newly created rural emergency hospital designation that focuses on providing ED services and observation care with appropriate transfer protocols to tertiary facilities with reimbursement at 105 percent of Hospital Outpatient Prospective Payment System rates
• Added 1,000 new physician graduate medical education slots starting in 2023

Looking Ahead: Key Issues Continue into 117th Congress

Many ongoing legislative issues will continue to be a priority for ACEP with this new Congress, including:

• Pushing for more COVID-19 relief, including more resources for vaccine manufacturing and distribution; supply chain stabilization and improvements; sufficient PPE supplies and improved testing, tracing, isolation, and treatment; and ensuring better preparedness for future pandemics
• Advocating for the Dr. Lorna Breen Health Care Provider Protection Act, prioritizing mental health services for physicians and other health care workers
• Advocating for adequate Medicare reimbursement (temporary sequestration ends March 31)
• Lobbying to eliminate the DEA X-waiver to treat patients with opioid use disorder
• Improving measures to decrease workplace violence in the emergency department
• Expanding emergency medicine telehealth opportunities

As you can see from the list above, ACEP advocacy work continues, and there is always a need for more grassroots assistance. If you’d like to be further plugged in to ACEP’s advocacy efforts, we encourage you to join the ACEP 911 Legislative Grassroots Network.

Ms. Grantham is ACEP’s communications manager.