Emergency Medicine Provisions Included in Senate and House Bills

ACEP News
October 13, 2009

The Senate Finance Committee finally approved its long awaited health care reform legislation by a vote of 14-9. The $829 billion overhaul does not include a public option, but subsidizes insurance for poorer Americans, establishes nonprofit health care cooperatives and creates health insurance exchanges to make it easier for small groups and individuals to purchase coverage.

The bill also replaces a scheduled 21% Medicare payment cut with a 0.5% increase in 2010. The vote sets up a floor debate that could begin as early as next week.

ACEP's Washington, DC office has been working to include a number of emergency medicine provisions in the bills that will come before both chambers of Congress. The following emergency medicine proposals are included in one or more of the many bills currently under consideration.

Emergency Medicine Proposals

  • Inclusion of emergency services as part of any essential health care benefits package.
  • Medicare physician payment reforms:
    • 2010 update based on inflationary Medicare Economic Index (MEI),
    • Resets budget baseline for SGR,
    • Excludes non-physician items from annual spending target, and
    • Increases allowable future volume growth for E&M services to GDP +2%
  • Emphasis on ED patient through-put as a measure used to determine quality improvement.
  • Statutory authorization of Emergency Care Coordination Center (ECCC) and ECCC's Council on Emergency Medicine within HHS' Office of the Assistant Secretary of Preparedness and Response (ASPR).  Requires ECCC to provide annual report to Congress on its programs (with focus on ED crowding and boarding).
  • Grants to conduct emergency care/trauma regionalization pilot projects.
  • Grants for economically troubled trauma centers.
  • Reauthorize Emergency Medical Services for Children (EMSC) program for five years.
  • HHS incentive payments to states that establish medical liability reforms, including Certificate of Merit and/or "early offer" programs.
  • HHS demonstration project to reimburse privately owned psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.
  • Require health plans that offer coverage in insurance Exchange to provide emergency services without regard to prior authorization or EP's contractual relationship with health plan.  Out-of-network co-pays and cost-sharing may not be higher than in-network rates.

Emergency Medicine Proposals Still Pending (or Being Considered)

  • Establish CMS working group to develop boarding and ambulance diversion standards/quality measures for hospitals.
  • Provide a 5% Medicare reimbursement bonus for services provided by emergency and on-call physicians (FY 2010 - FY 2015).
  • Exempt emergency and on-call physicians from 0.5% across-the-board reduction in Medicare reimbursements in FY 2010.
  • Regulate lawsuits for health care liability claims related to emergency department care.
  • Reauthorize Section 1011 of the 2003 Medicare Modernization Act (Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens).

 

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