• Health Care in the 115th Congress

    View the latest issues impacting the practice of emergency medicine.

    ER Docs on the Hill

  • Host an ED Visit for your Legislator

    Invite your legislator to see first-hand the challenges facing emergency physicians on a daily basis.

    Learn More

  • 911 Network Member? Get Involved!


    Learn about the different levels of participation and activities in the 911 Legislative Network.

    Levels & Activities

  • Weekly Update, September 21, 2018

    •Out-of-Network Reimbursement Discussion Draft Released in Senate; •Senate Approves Comprehensive Opioid Package; •Senate Advances Bill Funding Federal Health Care Programs; •ACEP Participates in Drug Shortage Summitl; •HHS Efforts to Fight the Opioid Epidemic; •NEMPAC at ACEP18; •Save the Date: 11/30 – 12/1 Specialty Physician and Dentist Candidate Workshop in Washington, DC; Read More
  • Weekly Update, September 14, 2018

    •House, Senate Pass First FY2019 “Minibus” Funding Bill; •Congress Reaches Deal on FY2019 Labor/HHS Funding Package; •Hurricane Florence Delays Senate Vote on Opioid Package; •House Energy & Commerce Committee Advances Several Drug Pricing Bills; •ACEP Response to the Annual Medicare Physician Payment Proposed Rule; •NEMPAC at ACEP18 ; •Save the Date: 11/30 – 12/1 Specialty Physician and Dentist Candidate Workshop in Washington, DC; Read More
  • Weekly Update, September 7, 2018

    •Capital Minute; •ACEP Participates in NASEM Drug Shortage Workshop; •Prescription Drug Pricing Bills Advance in Congress; •ACEP Contributes to Development of Fentanyl Safety Video for First Responders Released by Federal Workgroup; •Federal Advisory Committee Recommends ACEP-Proposed Alternative Payment Model to HHS; •NEMPAC at ACEP18; •Save the Date: 11/30 – 12/1 Specialty Physician and Dentist Candidate Workshop in Washington, DC Read More
  • Weekly Update, August 24, 2018

    • Capital Minute; • Senate Advances FY 19 Funding for Health Programs; • CMS Releases the Medicare Shared Savings Program Proposed Rule; • NEMPAC News; Read More
  • Weekly Update, August 3, 2018

    •Senate Approves Defense Authorization Bill with ACEP Provision, Awaits President’s Signature; •Senate Committee Continues Hearings to Examine Health Care Costs; •CMS Release the Inpatient Prospective Payment System Final Rule; •Trump Administration Releases Final Rule on Short-Term Limited-Duration Health Plans; •Congressional Recess; Read More
  • Weekly Update, July 27, 2018

    •House Approves Defense Authorization Bill with ACEP Provision; •ACEP Participates in Roundtable Discussion About Health Care Costs; •Sickle Cell Disease Legislation Advances in Senate; •ACEP Endorses Student Loan Bill; •House Committee Reviews 21CC, MACRA, and MIPS; •CMS Releases Medicare Outpatient Hospital Proposed Rule; •Congressional Recess; Read More
  • Weekly Update, July 20, 2018

    •Drug Shortages Task Force Convened: Thank your lawmaker today!; •House Committee Advances Emergency Preparedness Bill; •Congressional Committees Continue Hearings on Health Care Costs; •Emergency Physician Due Process Bill Introduced in House; •Administration Continues Work on Drug Pricing; •CMS Hosts Panels and Listening Sessions to Promote the Physician Fee Schedule and Quality Payment Program Proposed Rule; Read More
  • Weekly Update, July 13, 2018

    •Check out the latest ACEP Capital Minute; •Following ACEP’s Call to Action, FDA Responds with New Drug Shortage Task Force; •CMS Releases CY 2019 Physician Fee Schedule and Quality Payment Program Proposed Rule; •ACEP Responds to the HHS Blueprint on Drug Prices; •House Committee Advances Health Care Spending Bill; Read More
  • Weekly Update, June 29, 2018

    •Check out the latest ACEP Capital Minute; •ACEP President-Elect Resigns; Interim Chosen; •House Committee Considers Emergency Preparedness Legislation; •Senate Committee Advances HHS Funding Bill; •Senate Committee Holds Hearing to Examine Health Care Costs; •ACEP Submits Comments to CMS on Price Transparency; •CMS announces Final MIPS Scores for 2017 Performance Period Affecting Medicare Payments in 2019; Read More
  • Weekly Update, June 22, 2018

    House Passes Final Sections of Opioid Package; ACEP Leaders Discuss Mental Health with Lawmakers; ACEP Responds to DHS Policy on Family Separations; Department of Labor Releases Association Health Plans (AHPs) Final Rule; Request for Information on Physician Self-Referral Law; Trump Administration Releases Plan to Reorganize the Government; Read More

  • Weekly Update, June 15, 2018

    • Drug Shortage Crisis: Congress and the FDA Respond; • Opioids: ALTO and POWER Acts Pass the House; • House Committee Advances Labor-HHS Spending Bill; • Senate Committee Reviews Drug Prices; • Check out the latest ACEP Capital Minute ; • MedPAC Officially Releases Emergency Department Recommendations; Read More

  • Weekly Update, June 8, 2018

     • REMINDER: Urge Your Legislators to Sign Congressional Letter on Drug Shortages;  • Senate Cancels August Recess – For Now;  • ACEP Tele Town Hall on Gun Violence and Injury Prevention with Rep. Seth Moulton;  • House Passes $15 Billion Rescissions Package;  • U.S. Department of Justice Pushes New Effort to Dismantle ACA;  • House Committee Begins Review of Preparedness Response Programs;  • 2018 Medicare Trustees Report Released, Read More

  • Weekly Update, May 25,2018

    • Emergency Physician Testifies Before Senate Aging Committee Hearing; • Congressman Raul Ruiz, MD, Offers Resolution Honoring ACEP’s 50th Anniversary; • Senate Finance Committee Releases 22 New Opioid Bills; • Senate Committee Advances Disaster Preparedness Bill; • CMS Releases Rule Related to Title X/Family Planning Funding; • ACEP Response to CMMI Request for Information on Direct Provider Contracting; • Register for ACEP's Gun Violence & Injury Prevention Tele-Town Hall on June 5 Read More

  • Weekly Update, May 11, 2018

    • Drug Pricing Proposal • E&C Opioids Markup – ACEP Bills Continue Progress • Emergency Physician Testifies before House Judiciary Committee Hearing on Opioid Epidemic • Check out the latest ACEP Capital Minute • CMS Updates QPP Website to Include 2018 MIPS Eligibility for Groups • Don't miss ACEP's Gun Violence & Injury Prevention Tele-Town Hall on June 5: Register Today! Read More

  • Weekly Update, May 4, 2018

    • Help ACEP Go Viral with New Videos about Anthem Denials of Emergency Coverage;• ACEP Responds to HELP Committee PAHPA Draft;• Save the Date: ACEP Town Hall on Gun Safety June 5, 2018;• ACEP Response to the “Controlled Substances Quotas” Proposed Rule Read More

  • Weekly Update, April 27, 2018

    • Opioid Bills Move Forward in House and Senate-- Two ACEP Bills Included• 2019 National Defense Authorization Act Includes ACEP Language on PDMPs• PAHPA Draft Released• Check out the latest ACEP Capital Minute• CMS Releases Fiscal Year 2019 Medicare Hospital Inpatient Prospective Payment System Proposed Rule• ACEP Response to the “Short-Term, Limited-Duration Insurance” Proposed Rule• NEMPAC Activities at LAC18• Congressional Dine-Arounds during LAC18; Read More
  • Weekly Update, April 20, 2018

    • ACEP Continues to Advocate for ED-Specific Opioid Bills in Senate; • Other Congressional Actions on Opioids; • NEMPAC Activities at LAC18; • Congressional Dine-Arounds during LAC18; Read More
  • Weekly Update, April 13, 2018

    • Congress Continues Frenetic Pace on Opioid Efforts; • House Appropriations Committee Begins Work on FY2019 Budget; • Speaker Paul Ryan Announces Retirement; • Check out the latest ACEP Capital Minute; REGULATORY UPDATE• ACEP Responds to the “Protecting Statutory Conscience Rights in Health Care; Delegations of Authority” Proposed Rule; • Opioid Policies for Medicare Prescription Drug Plans; • MedPAC Recommendations on Freestanding Emergency Department Payment Rates; • Final Policies for the Exchanges; 2018 ACEP LEADERSHIP AND ADVOCACY CONFERENCE; New Speakers and Sessions Confirmed; o NEMPAC VIP Reception, Sunday, May 20 at the International Spy Museum; o Congressional dine-arounds with legislators confirmed. Read More
  • Weekly Update, March 23, 2018

    • ACEP Witness Testifies Before Congress on Opioid Proposals; • Congress Clears Omnibus Spending Bill; • ACEP Comments on MACRA Implementation; • New Advocacy Sessions Announced for LAC18. Register Now: May 20-23, 2018 in Washington, DC!, Read More

  • Weekly Update, March 16, 2018

    • ACEP Invited to Ways & Means Roundtable on Physician Burdens, • More Scrutiny for Anthem on its Emergency Care Denials Policy, • ACEP Responds to Ways & Means Committee Request on Opioid Epidemic, • ACEP Meets with House Armed Services Committee to Address PDMP Data Sharing, • Response to the “Reimbursement for Emergency Treatment” Interim Final Rule, • Check Out the Latest ACEP Capital Minute, • LAC18 Topics and Speakers Announced - Register Now, Read More...
  • Weekly Update, March 9, 2018

    • ED-Specific Opioid Bills Introduced, Senators Call on HHS and DOL to Uphold PLS, ACEP Response to the Calendar Year (CY) 2019 Advanced Notice and draft Call Letter, ACEP Response to the Proposed Definition of “Employer” under Section 3(5) of ERISA -- Association Health Plans, ACEP Fact Sheet on Exemptions for the Advancing Care Information Category (ACI) of the Merit-based Incentive Payment System (MIPS), Congressional Hearings This Week... Read More.
  • Weekly Update, March 2, 2018

    • Mark Rosenberg, DO, FACEP, Appointed to Federal Opioid Task Force, Congress Continues Efforts on Opioid Epidemic, MISSION Zero and Other ACEP-supported Legislation Successfully Passed in House, ACEP Capital Minute, Registration Open for LAC18 in Washington, DC Read More
  • Weekly Update, February 16, 2018

    • Anthem Revisions to ED Denials Program Still Not Enough; • HHS Secretary Azar Testifies Before House Panels; Open to Research on Gun Violence; • Good Samaritan Bill Approved by Full E&C Committee; Registration Now Open for the 2018 Leadership & Advocacy Conference (LAC18) May 20-23... Read More.

  • Weekly Update, February 2, 2018

    • President Trump Gives First State of the Union Address, Latest on Government Funding Deal, FDA Considers Public Input on Opioid Strategies, CDC Director Resigns Over Conflicts of Interest, Debt Limit Deadline Moves Up, LAC18 Registration Now Open, Read More
  • Weekly Update, January 26, 2018

    • ACEP Capital Minute, Congress Approves Another Short-Term Funding Bill, ACEP President Meets with CMS and U.S. Lawmakers, HHS Secretary Nominee Confirmed, Hearings, Read More...
  • Weekly Update, January 19, 2018

    • Congress Faces Potential Government Shutdown, ACEP Exposing Anthem’s Unlawful Emergency Care Policy with New Video, HHS Issues New Conscience Protection Rule, Senate Holds Initial PAHPA Hearing, “Good Samaritan” Liability Bill Advances, ACEP Comments on Medicare Advantage and Part D Rule, ACEP Advocacy Survey and Winner of Amazon Gift Card, Read More...
  • Weekly Update, January 12, 2018

    • Congress Begins Second Session of 115th Congress, ACEP Capital Minute Video Update, Legislative Items Left-Over from 2017, HHS Secretary Nominee Confirmation Hearing, MedPAC Recommends Repealing MIPS, VA Issues Rule Regarding Reimbursement for Emergency Health Care Services, Read More...
  • Vote No on Cassidy/Graham Proposal - Action Alert

    Click here to act now! TELL YOUR SENATORS TO VOTE “NO” ON THE CASSIDY/GRAHAM HEALTH REFORM PROPOSAL...Read More on this Action Alert
  • Weekly Update, September 22, 2017

    • Senate Working Towards Vote on Latest ACA Repeal Before Deadline; • ACEP’s Capital Minute with Dr. Paul Kivela, ACEP President-Elect; • Trump Administration Considers Changes to CMS’ Innovation Center; • White Coat Day on Capitol Hill is November 1 during ACEP17 in Washington DC...Read More.
  • Weekly Update, September 15, 2017

    • Children’s Health Insurance Program to Be Extended; • ACEP Meets with Lawmakers to Discuss VA Issues; • ACEP Weighs in On Medicare Proposed Physician Fee Schedule; • Senate Works on Plan to Stabilize Individual Insurance Market; • Senators Introduce Another Bill to Repeal ACA; • Senator Introduces Single-Payer Bill; • House Approves Final FY 2018 Appropriations Bills Mark-Ups; • Rep. Anthony Brown Visits Local Emergency Department; • White Coat Day in Washington DC is November 1 during ACEP17...Read More.
  • Weekly Update, September 8, 2017

    • Congress Clears Disaster Relief Package and Other Temporary Extensions; • Time Running Out in Senate for Obamacare Repeal; • Senate Committee Examines Individual Insurance Marketplace Stabilization; • Senate Committee Looks at Children’s Health Insurance Program (CHIP); • Senate Appropriators Approve HHS Spending Bill; • Nov. 1 is White Coat Day on Capitol Hill during ACEP17...Read More.
  • A Thank You from ACEP President Rebecca Parker

    A Thank You Message from ACEP President Rebecca Parker Regarding Recent Congressional Activity on Health Care Reform...Read More.
  • Weekly Update, July 28, 2017

    • Senate Fails to Advance Health Care Reform Legislation; • House Committee Advances Trauma Bill; • House Approves First Bundle of FY 18 Appropriations...Read More.
  • Vote No on Motion to Proceed - Action Alert

    Click here to act now! FINAL PUSH TO STOP CONSIDERATION OF DANGEROUS HEALTH CARE LEGISLATION IN THE SENATE...Read More
  • Weekly Update, July 21, 2017

    • Senate Scheduled to Vote on Health Care Repeal Next Week – Maybe; • House Committee Advances Fiscal Year 2018 Funding for Health Programs; • House Committee Approves FY 18 Budget; • AK ACEP Members Participate in Health Care Roundtable with Senator Lisa Murkowski (R-AK); • MD ACEP Members Meet with Senator Ben Cardin (D-MD); • Regulatory Update...Read More.
  • Weekly Update, July 14, 2017

    • Revised Senate Health Care Bill Released • ACEP Supports Legislation to Promote Use of Advance Directives • House Approves FDA Reauthorization Bill • House Committee Advances Funding for Health Programs • House Approves Human Trafficking Bill • Medicare Trustees Report – IPAB Trigger Delayed...Read More.
  • Keep Up the Pressure! EM is an EHB Action Alert

    Click Here to Act Now! NEW PUBLIC POLL: EMERGENCY CARE IS THE MOST ESSENTIAL HEALTH BENEFIT TO COVER - Nearly three in four Americans say that health insurance companies must be required to cover emergency medical services as part of any health care replacement bill, according to a new poll by Morning Consult. According to the poll, emergency services rated the highest of the 10 essential health benefits, with 73 percent of the public saying it was “very important” to keep...Take Action!
  • Weekly Update, June 30, 3017

    • Senate Health Care Bill Falters; • ACEP ACTION ALERT – VOTE “NO” on the BCRA; • ACEP Shares Regulatory Reform Ideas with HHS Secretary; • House Approves Medical Liability Reform Bill; • House Committee Approves Trauma Bill; • House Committee Reviews Synthetic Drug Bill; • Surgeon General Nominee...Read More
  • BCRA Action Alert

    CONTACT YOUR U.S. SENATORS TODAY: URGE THEM TO OPPOSE THE “BCRA” AND GO BACK TO THE DRAWING BOARD! Click here to Act Now!
  • Weekly Update, June 23, 2017

    • ACEP Opposes Draft Senate Health Care Reform Bill; • ACEP Discusses Physician Resiliency with Congressional Doctors Caucus; • ACEP Member Testifies on Ethical Responsibilities of Attorney Advertising; • Rep. Raul Ruiz Holds Press Conference to Examine Health Reform Efforts...Read More.
  • Weekly Update, June 9, 2017

    • ACEP President Meets with Key Senate Offices to Discuss Health Care Reform; • House Committee Approves FDA Bill; • Additional Cosponsors Added to EMTALA Liability Bill; • HHS Secretary Discusses FY2018 Budget Proposal; • Upcoming Hearings of Interest to EM...Read More.
  • Weekly Update, May 26, 2017

    • ACEP Shares Health Reform Principles with Key Senate Committee; • Congressional Budget Score on AHCA Bill; • White House Releases FY2018 Budget Request; • FDA Calls for More Forceful Steps to Combat Opioid Epidemic; • Congressional Hearings & Mark-ups This Week; • ACEP Participates in National EMS Week Exhibit and CPR Training on Capitol Hill...Read More.
  • Weekly Update, May 19, 2017

    • Possible, but Unlikely, Re-Vote in House on AHCA; • Senate Marks Up Chronic Care Legislation; • Rural Emergency Acute Care Hospital Act Re-introduced; • Good Samaritan Bill Reviewed by House Committee; • Congressional Hearings...Read More.
  • Weekly Update, May 12, 2017

    • Attention on Health Care Reform Turns to Senate; • FDA Commissioner Confirmed; • Senate HELP Committee Advances FDA User Fee Bill; • Center for Consumer Information and Insurance Oversight (CCIIO) Has New Director; • Additional Co-sponsors for EMTALA Liability Bill...Read More.
  • Weekly Update, May 5, 2017

    • House Approves Controversial Health Care Reform Bill; • Congress Avoids Government Shutdown; • Trauma Bill Introduced in Senate; and • ACEP Promotes Innovative Opioid Solutions...Read More
  • Weekly Update, April 28, 2017

    • House Delays Vote on AHCA; • ALERTCONTACT CONGRESS ABOUT HEALTH CARE REFORM BILL; • CR Funds Government for another Week; • EMS Standing Orders Bill Advances in Senate; • WH Nominates New Assistant Secretary for Mental Health and Substance Use; • WH Dismisses Surgeon General; and • FDA Nominee Clears Committee Hurdle...Read More.
  • Weekly Update, April 7, 2017

    • Senate Confirms Supreme Court Nominee; • Vice President Casts Tie-Breaking Vote on Family Planning Bill; • House GOP Eager to Keep ACA Repeal Alive; • Self-Insurance Bill Passes House; • Additional Cosponsors Added to EMTALA Liability Bill; • ACEP Advocacy Action Alert; • Senate HELP Hearings...Read More.
  • Weekly Update, April 3, 2017

    House Republicans’ Efforts to Repeal ACA Stalled – What Next?; HHS Secretary Price Testifies at Appropriations Hearing; Trump Administration Proposes $1.2 Billion Cut at NIH this Year; President Creates Task Force to Study Drug Addiction and Opioid Abuse; ACEP’s 2017 Leadership & Advocacy Conference; 911 Network Member of the Year; NEMPAC at LAC...Read More.
  • Special Edition, March 24, 2017

    Update on House Vote to Repeal and Replace the ACA...Read More.
  • Weekly Update, March 17, 2017

    • CMS Administrator Confirmed and Joint HHS/CMS letter to Governors; • Budget Impact of American Health Care Act; • Repeal Effort Moving Quickly Through House; • President’s Budget Blueprint Released; • Parker and Hirshon Host News Conference; • MedPAC Releases Payment Policy Report...Read More.
  • Legislative Update, March 15, 2017

    Congressional Actions Tomorrow on the American Health Care Act (AHCA) and Efforts to Repeal and Replace the ACA...Read More.
  • Weekly Update, March 10, 2017

    •ACA Repeal Legislation in the House; •Senate Advances CMS Nominee; •House Approves Lawsuit Abuse Bill; • House Education and Workforce Committee Legislation; •Observation Status Legislation Reintroduced to Improve Access to Medicare; • Virtual LAC17...Read More.
  • Weekly Update, March 3, 2017

    • President Outlines Health Care Reform Principles during Congressional Address; • Republican Leaders Continue to Work on ACA Repeal/Replace Plan; • Senate Version of EMTALA Liability Bill Introduced this Week; • CMS Administrator - Nominee Advances; • Hearings and Mark-ups; •2017 Leadership and Advocacy Conference is Almost Here...Read More.
  • Weekly Update, February 17, 2017

    • Senate Finance Committee Holds Confirmation Hearing for CMS Administrator; • Shulkin Confirmed as Next Secretary of Veterans Administration; • Prudent Layperson Standard Discussed on Senate Floor; • Legislation Introduced to Combat Synthetic Drug Trafficking; • Cosponsors Added to EMTALA Liability Bill; • Congressional Hearings; • 2017 Leadership and Advocacy Conference...Read More
  • Weekly Update, February 10, 2017

    • ACEP and EMRA Board Members in Washington, DC; • ACEP President Becky Parker Hosts Teleforum with Rep. Diane Black (R-TN); • Dr. Price Confirmed As New Secretary of HHS; • Nominee for VA Secretary Advances; • ACA Repeal-Replace Legislation Under Consideration; • Congressional Hearings; • 2017 Leadership and Advocacy Conference...Read More.

  • Weekly Update, February 3, 2017

    • Price Nomination Advances; • Rep. Dent Briefs ACEP Committee on Health Care Reform; • Surprise Billing Legislation Re-introduced; • White House Clarifies Executive Order to Reduce Federal Regulations; • ACA Hearings; • IPAB Repeal Bills Introduced; • Supreme Court Nomination; • ACEP Leadership and Advocacy Conference...Read More.

  • Weekly Update, January 27, 2017

    • Congressional Hearings to Examine the ACA Begin Next Week; • Two Bills Introduced in Senate as Replacement Options to the ACA; • ACEP-supported EMTALA Liability Relief Bill Reintroduced; • HHS Nominee Confirmation Hearings; • Kari’s Law Passes House; • Health Agency Communications Restricted; • 2017 Leadership and Advocacy Conference...Read More.

  • Weekly Update, January 13, 2017

    • House Passes EMS Standing Orders Bill; • House and Senate Pass Budget Resolution Paving Way for ACA Repeal and Replace Efforts; • ACEP Health Care Reform Principles; • Trump Administration Nominees; • Register for ACEP Leadership & Advocacy Conference - See a special message below from confirmed speaker ZDoggMD...Read More.

  • Weekly Update, January 9, 2017

    Capitol Hill is bustling with activity as members of the 115th Congress were sworn in on January 3. Already major health reform issues are at the top of the agenda. From the Affordable Care Act (ACA) to Medicare, the stage is set for Congress and President-elect Donald Trump's administration to attempt significant changes to health care policy in 2017.

    What’s Ahead this Week:
    •Senate confirmation hearings are slated to begin this week on President-elect Trump’s Cabinet nominees. Democrats are expected to use procedural tools to delay confirmation of his most controversial picks. But only a simple majority is needed in the Senate to confirm nominees after rule change in 2013, so an easy confirmation vote is expected for most of Trump’s choices. Hearings this week include: John Kelly for the Department of Homeland Security; Sen. Jeff Sessions for Attorney General; Rex Tilson for Secretary of State; Betsy DeVos for Education secretary; Rep. Mike Pompeo, to lead the CIA; Elain Chao for Labor Dept; Ben Carson for Housing and Urban Development; and Wilbur Ross for the Commerce Department.

    •A budget resolution which Republicans will use to fast-track legislation to repeal the Affordable Care Act is on the Senate floor this week. The next vote is scheduled for 5:30 p.m. Monday, on an amendment filed by Sen. Rand Paul (R-KY) to balance the budget. He opposes the GOP-drafted budget proposal because it increases debt by about $9 trillion. On Tuesday, the Senate will vote on an amendment to the budget filed by Sen. Bernie Sanders (I-VT) that would prevent cuts to Social Security, Medicare and Medicaid. Later in the week, the chamber will complete votes on all remaining budget amendments in the marathon “vote-a-rama.”

    •Across the Capitol, the House is slated to consider a package of bills aimed at increasing congressional oversight over regulations that affect businesses and job growth. The legislation is the third plank in House Republicans’ early 2017 push on regulatory reform.

    In this issue:
    • ACA Repeal and Replace
    • ACEP Health Care Reform Principles
    • Key Health Care Committee Assignments
    • EMS Standing Order Legislation Re-introduced 
    • Register for ACEP Leadership & Advocacy Conference Today!

    ACA Repeal and Replace
    On Tuesday just hours after members of the 115th Congress were sworn in, Senate Budget Committee Chair Mike Enzi (R-WY) introduced a budget resolution that initiates Republican efforts to repeal the ACA, making good on the GOP's promises coming out of the 2016 general election. The resolution, which the Senate will vote on this week, would direct committees in the House and Senate to draft and approve legislation that, among other things, will repeal major parts of the ACA. The resolution gives the committees until Jan. 27 to do so.

    The move comes with pushback from various stakeholders—including some Republican lawmakers —who say Republicans should introduce a plan to replace the ACA before they repeal the law.

    On Wednesday, a group of conservative House Republicans unveiled an ACA replacement plan that would increase access to health savings accounts, expand federal support for states to establish high-risk pools, and allow insurers to sell health plans across state lines. The 184-page bill, titled “The American Health Care Reform Act of 2017,” has been previously introduced without much support from Republican leadership. The bill would fully repeal all aspects of President Barack Obama's signature health care law effective January 1, 2018, if enacted. Overall, Republicans have yet to coalesce on any one replacement plan -- many competing plans are swirling around and sorting them out could optimistically take months.

    Also last Wednesday, President Barack Obama and Vice President-elect Mike Pence visited Capitol Hill to rally their parties for the ensuing battle over the health care law.

    ACEP Healthcare Reform Principles Sent to Hill Leaders
    ACEP wants to be a constructive participant in the upcoming decisions regarding the future of health care with the goal of maximizing access, improving quality and reducing costs. An overview of ACEP’s key principles for health care reform was sent to Hill leaders this week. The letter is available on the ACEP Advocacy website. The principles document will be available later this week.

    Key Health Care Committee Appointments in the New Congress
    Senate Finance Committee: New members of the committee in the 115th Congress are Sens. Bill Cassidy (R-LA), a physician member of the Senate, and Sen. Claire McCaskill (D-MO).

    Senate Health, Education, Labor and Pensions (HELP): New members are Sens. Todd Young (R-IN), Maggie Hassan (D-NH) and Tim Kaine (D-VA).

    Energy and Commerce Committee: Rep. Michael Burgess (R-TX), was named the chair of the Energy and Commerce health subcommittee this week. Dr. Burgess, a TX ob-gyn in his 8th term, replaces former Rep. Joe Pitts (R-PA), who retired last year. Rep. Brett Guthrie (R-KY) will be the panel’s vice chair. Dr. Burgess called the selection a “career honor” since leaving private practice 14 years ago to run for Congress. ACEP/NEMPAC has been long time supporters and admirers of Congressman Burgess (R-TX). He played a pivotal role in the repeal of the SGR and introduction of MACRA and MIPs. He’s been a tireless friend of medicine and of emergency medicine. The Energy and Commerce Committee will be a major player in the upcoming changes to the healthcare delivery system. Other new member to E&C include Reps. Buddy Carter (R-GA), Ryan Costello (R-PA), Tim Walberg (R-MI), and Mimi Walters (R-CA). NEMPAC has supported all of these members in their elections to Congress and looks forward to working with them on important health care issues.

    On the Democratic side, Rep. Raul Ruiz (D-CA) was named to the Energy and Commerce Committee. Dr. Ruiz is a board-certified emergency physician who has been supported by ACEP/NEMPAC since his election to Congress in 2012. Other new members to E&C on the democratic side of the aisle are Reps. Debbie Dingell (D-MI) and Scott Peters (D-CA).

    Ways and Means Committee: Reps. David Schweikert (R-AZ), Jackie Walorski (R-IN), Carlos Curbelo (R-FL), Brian Higgins (D-NY), Terri Sewell (D-AL), and Suzan DelBene (D-WA) will serve as new members of the influential House Ways and Means Committee. Rep. Kevin Brady (R-TX) remains the chairman of the full Committee and Rep. Pat Tiberi (R-OH) will remain the chairman of the Health Subcommittee. Rep. Richard Neal (D-MA) takes over as ranking member of the Committee, replacing Sander Levin (D-MI), who retired.

    EMS Standing Orders Legislation Reintroduced in 115th Congress
    The "Protecting Patient Access to Emergency Medications Act of 2016," almost made it to the finish line in the 114th Congress but was held up in the final hour in the Senate. The House passed the bill by voice vote on Nov. 14.

    The legislation was reintroduced in the new Congress last week by its original sponsors, Rep. Richard Hudson (R-NC) and Rep. G.K. Butterfield (D-NC) as H.R. 304. The House is scheduled to take up the bill today. This legislation has been a priority for ACEP for the last two years. The bill would ensure continued access to pain and anti-seizure medications for patients suffering medical emergencies. It will explicitly permit physician medical directors to issue standing orders to EMS personnel so they may administer controlled substances to their patients. In addition, the legislation clarifies and codifies who is authorized to provide verbal orders for controlled substances; provides the option for a single EMS agency registration; and clarifies receipt, movement and storage rules for EMS agency controlled substances. ACEP will continue to work with a coalition of stakeholders to gain congressional approval early in the year.

    ACEP Leadership & Advocacy Conference – Mark your calendar!
    With a new Administration, Congress, and legislative agenda, the need for your involvement is greater than ever before. Please join your colleagues and emergency medicine leaders from across the country at ACEP’s 2017 Leadership and Advocacy Conference, March 12-15, 2017. For further details about the meeting and to register, please click here.

  • Weekly Update, December 12, 2016

    The House took its last vote of the 114th Congress and then adjourned last Thursday. The Senate followed suit on Saturday morning. Both chambers will be in pro forma session for the remainder of the year and they will reconvene on Jan. 3, 2017 to begin the 115th Congress.

    Several key proposals and issues of importance to emergency medicine were successfully approved during the lame duck session. Some of these issues were included in the key messages taken to Capitol Hill by more than 500 ACEP members who attended ACEP's Leadership and Advocacy Conference in May, and all were part of ACEP's legislative agenda for the year.

    In this issue:
    • ACEP Supported "21st Century Cures Act" Sent to President
    • VA Legislation Includes ACEP-Supported Emergency Medicine Provisions
    • Congress Approves Short-Term Funding Extension
    • Republicans Win Runoffs in Final 2016 Races
    • Register for ACEP Leadership & Advocacy Conference Today!

    ACEP Supported "21st Century Cures Act" Sent to President
    On Wednesday, the Senate approved H.R. 34, the "21st Century Cures Act," by a vote of 94 to 5. The ACEP-supported legislation included key provisions regarding interoperability, mental health and opioid funding. Specifically, the bill provides strong interoperability and data sharing provisions for electronic health record (EHR) technologies. These provisions, which ACEP advocated for since the bill's inception, are critical to ensure clinician-led clinical data registries, such as ACEP's Clinical Emergency Data Registry (CEDR), will be able to promote quality improvements and medical research.

    H.R. 34 also included the compromise mental health language from the "Helping Families in Mental Health Crisis Act of 2016" that ACEP has been actively supporting over the past several years and that was promoted during LAC. Provisions of particular interest to ACEP include: Creation of an Assistant Secretary for Mental Health and Substance Use and the National Mental Health and Substance Use Policy Lab; extension of the Assisted Outpatient Treatment (AOT) grants and institution of grants for Assertive Community Treatment; establishment of liability protections for health professional volunteers at Community Health Centers; extension of suicide prevention programs; reauthorization of grants to help train emergency medical personnel to recognize individuals with mental health issues and how to intervene; direction to CDC to improve its National Violent Death Reporting System; expansion of the mental health workforce; clarification of HIPAA privacy rules for patients with mental illness and their caregivers; eliminating the Medicaid same-day exclusion; studies seeking information about Medicaid managed care plan provision of services for adults at an Institution for Mental Diseases (IMD) and the level of participation in the Medicaid Emergency Psychiatric Demonstration Project; and enhanced compliance with mental health and substance use disorder insurance coverage.

    Finally, H.R. 34 includes $1 billion (over two years) to supplement opioid abuse prevention and treatment activities and nearly $5 billion (over 10 years) in additional funding for the NIH.

    The House had previously approved the same bill on Nov. 30 by a vote of 392 to 26. President Obama will sign the bill into law tomorrow.

    To read ACEP's letters of support, click here.

    VA Legislation Includes ACEP-Supported Emergency Medicine Provisions
    During the past several days, the U.S. Congress took action to overwhelmingly approve H.R. 6416, the "Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016." ACEP successfully advocated for the inclusion of several key emergency medicine provisions in the bill. One measure, sponsored by emergency physician Rep. Raul Ruiz (D-CA) and Rep. Brad Wenstrup (R-OH) in the House and Sen. Mazie Hirono (D-HI) in the Senate, would create more flexibility in how VA emergency department scheduling is performed. Instead of adhering to the strict 80 bi-weekly hours, this legislation will allow them to work more or less than the current requirement to facilitate better coverage of VA emergency departments (provided they work at least 2,080 hours annually). The bill also codifies the patient protections afforded by EMTALA and the Prudent Layperson Standard for VA emergency care. The House of Representatives voted 419 to zero in favor of the bill on Tuesday and the Senate cleared the bill Thursday by voice vote. The bill is being sent to the president for his signature and enactment into law, which should occur before the end of the year.

    Congress Approves Short-Term Funding Extension
    Congress approved another Continuing Resolution (CR) this week to fund federal agencies and programs through April 28, 2017, barely averting another government shutdown. This legislation, the "Energy and Water Development and Related Agencies Appropriations Act, 2017" (H.R. 2028), keeps most government operations at the same level as FY 16 for the first seven months of the current fiscal year, which began Oct. 1, 2016, although it does include several policy and funding changes to provide flexibility to federal agencies and implement a few new programs. Some of those modifications include extra money for overseas war operations, disaster relief for Louisiana and other states that suffered severe weather events and money for communities facing lead-contaminated water. Money designated for programs in the "21st Century Cures Act" (see story above) include $500 million for opioid abuse programs, $352 million for NIH and $20 million for the FDA.

    The House approved H.R. 2028 by a vote of 326 to 96 on Thursday. The Senate approved the measure by a vote of 63 to 36 just prior to the midnight deadline on Friday.

    Republicans Win Runoffs in Final 2016 Races
    On Saturday, Louisiana's state treasurer, Republican John Kennedy, defeated Public Service Commissioner Foster Campbell (D) and will replace retiring Sen. David Vitter (R). This was the expected outcome and with this election, the make-up of the Senate in the 115th Congress will be 52 Republicans, 46 Democrats and two Independents (who caucus with the Democrats). In addition, Republicans will hold onto the two U.S. House seats that were vacated when Reps. Charles Boustany and John Fleming ran for the Senate. Clay Higgins, a former sheriff's captain, won in the 3rd District representing southwest and south central Louisiana. State Representative Mike Johnson won the 4th District, which covers northwest Louisiana.

    ACEP Leadership & Advocacy Conference – Mark your calendar!

    With a new Administration, Congress, and legislative agenda, the need for your involvement is greater than ever before. Please join your colleagues and emergency medicine leaders from across the country at ACEP’s 2017 Leadership and Advocacy Conference, March 12-15, 2017. For further details about the meeting and to register, please click here.

  • Weekly Update, December 2, 2016

    Both the Senate and House will be in session next week.

    Congress is expected to wrap up final actions for the 114th Congress next week possibly adjourning sine die on December 9. The only "must-pass" items are appropriations to fund the government beyond December 9 when the current continuing resolution (CR) expires and the National Defense Authorization Act (NDAA), which specifies the budget and expenditures for the Department of Defense. Republican leaders in both the House and Senate said Wednesday that a new stopgap spending bill to fund the government will almost certainly stretch into April and possibly longer due to the Senate's jam-packed 2017 schedule that will include confirmations of President-elect Donald Trump's Cabinet nominees. Items that are still being considered as possible add-ons to the short-term spending bill are funds for Flint disaster relief, overseas war operations and implementation of the 21st Century Cures bill.

    In this issue:

    • House Passes 21st Century Cures Act
    • Nominees for Health Agencies in the New Administration
    • Key Congressional Committee Chairs Announced
    • ACEP President in Washington, DC
    • Funding for Human Trafficking Hotline
    • Senate Advances Telehealth Bill
    • Make Your Voice Heard – Register for ACEP's Leadership & Advocacy Conference

    21st Century Cures Approved by House – Includes opioid funding and mental health reform
    On Wednesday, the House passed the 21st Century Cures Act by a vote of 392-26 (20 Republicans, 6 Democrats opposed and 17 not voting). The bill had some significant add-ons since the House first passed their version of an innovations bill on July 10, 2015 (by a vote of 344 to 77). Included of interest to ACEP are comprehensive mental health care reforms, primarily based on the modified House-approved bill (H.R. 2646) with some elements of the Senate bill (S. 2680); nearly $5 billion (over 10 years) in additional funds for NIH; and an additional $1 billion (over two years) for grants to states to supplement opioid abuse prevention and treatment activities. All three of these components are strongly supported by ACEP, as well as the critical provisions in the Cures Act that will promote and facilitate interoperability of clinical data and prevent electronic health record (EHR) vendors from blocking the transmission of such data to third parties, such as CEDR. The Senate is expected to take up the 21st Century Cures bill early next week in an effort to have the bill signed into law before the end of the year. To view ACEP’s letter of support for the bill, please click here. Thank you to all of the 911 Network members who emailed their legislators to urge their support of the bill.

    President-elect Trump’s Nominees for Top Health Agencies
    Earlier this week, President-elect Donald Trump announced his nominees to lead the nation’s top health agencies. Representative Tom Price (R-GA) has been nominated to lead the Department of Health and Human Services (HHS) and Seema Verma as the next administrator for the Centers for Medicare and Medicaid Services (CMS).

    Rep. Price, an orthopedic surgeon from Georgia first elected in 2004, is an active member of the influential House GOP Doctors Caucus and one of the original Tea Party Caucus members. He has served since 2015 as chairman of the House Budget Committee and has been a vocal proponent of repealing and replacing the Affordable Care Act as well as overhauling other major health programs like Medicare.

    Seema Verma is founder of the Indiana health policy consulting firm SVC Inc. She worked closely with Vice-President-elect Mike Pence when he was Governor of Indiana and is credited as the chief architect of the Healthy Indiana Plan, which has Medicaid recipients contribute financially to their care. Her consulting firm has worked with several states on reforming Medicaid programs, including Iowa, Kentucky, Ohio, Michigan, Maine and Tennessee.

    Key Committee Chairs Named this Week
    Rep. Greg Walden (R-OR) won a closed-door election to become the next House Energy and Commerce Committee chairman Thursday defeating Rep. John Shimkus (R-IL) the more senior member of the panel. The House Republican Steering Committee — a panel made up of leadership, chairmen and several dozen elected members representing different regions and elements of the GOP Conference - made the selection in a secret ballot election.

    Rep. Walden is the outgoing National Republican Congressional Committee Chairman and was focused throughout the year on maintaining the republican majority in Congress. Taking the reins of the Republican Conference’s fundraising arm in 2011, he played a key role in building the chamber’s largest GOP majority in 90 years. And despite pollster predictions that Republicans could lose as many as 20 seats this cycle, the Democrats picked up only six. As chairman, he will play a lead role in the effort to replace the ACA after Republicans vote to repeal the health care law and create a system of their own, a complicated process that could take years.

    Rep. Richard Neal (D-MA) was officially chosen today as the next ranking member on the House Ways and Means Committee. He will replace Rep. Sandy Levin (D-MI), who stepped down from the ranking member position after the November elections. Rep. Neal drew the backing of both the Democratic steering committee and the unanimous support of the full caucus. He is known for working across the aisle at Ways and Means, and will be taking the job at a complex time for Democrats, who will have to figure out how much to work with Republicans on tax and health care reform. Rep. Xavier Becerra (D-CA) also briefly sought the ranking member slot before being tapped to be California's attorney general earlier this week.

    Rep. Phil Roe (R-TN), a physician elected to Congress in 2008, will be the next chair of the House Veterans Affairs Committee. Dr. Roe has been vocal about the poor health record sharing between the military and veterans' health system and the need for a system wide overhaul. He will replace Rep. Jeff Miller (R-FL), who retired this year. Dr. Roe has advocated for the VA's EHR to be replaced with a commercial system.

    ACEP President Hits the Ground Running
    As part of ongoing efforts by ACEP to connect with key legislators and staff who will be part of major health care decisions in the next congress, ACEP President Rebecca Parker was in Washington, DC this week for a series of meetings and events. While in town, she met with Carla DiBlasio, health staff for Rep. Tom Price (R-GA), Matt Meyer, chief of staff for Rep. Phil Roe (R-TN), and Kelly Strickland, chief of staff for Rep. Mike Burgess (R-TX). She also attended a luncheon for supporters of Energy and Commerce Chairman Fred Upton (R-MI) and Speaker Ryan’s Holiday gathering at the Library of Congress.


    Matthew Parker, Speaker Paul Ryan and ACEP President Becky Parker

    Funding for Trafficking Hotline
    This week the Senate passed a bill to ensure funding for the National Human Trafficking Hotline. The bill sponsored by Senators Amy Klobuchar (D-MN) and John Cornyn (R-TX), amends the Victims of Trafficking and Violence Protection Act of 2000 to eliminate the provision that specifies that HHS national human trafficking hotline grants be funded by amounts made available to the Department of Justice for trafficking victim services grants. Currently, the bill is pending in the House.

    Senate Advances Bill to Study Effectiveness of Health Technology
    The Senate unanimously passed a bill on Tuesday to further study the effectiveness and potential of certain rural telemedicine programs. The ECHO Act (S. 2873), sponsored by Sens. Orrin Hatch (R-UT) and Brian Schatz (D-HI), asks HHS to examine this technology's impact on distance learning for medical providers and to report back to Congress on its expansion. It's primarily focused on the University of New Mexico's Project ECHO, which currently uses telemedicine to train rural providers to handle complex diseases across 30 states. A companion bill in the House is sponsored by Reps. Doris Matsui (D-CA) and Michael Burgess (R-TX), but no action is slated in the lame duck session this year.

    ACEP Leadership & Advocacy Conference – Mark your calendar!
    With a new Administration, Congress, and legislative agenda, the need for your involvement is greater than ever before. Please join your colleagues and emergency medicine leaders from across the country at ACEP’s 2017 Leadership and Advocacy Conference, March 12-15, 2017. For further details about the meeting and to register, please click here.

  • Network Alert, 21st Century Cures, November 29, 2016

    Contact your U.S. Representative to urge them to vote "Yes" for the “21st Century Cures Act”

    The House of Representatives will vote Wednesday on a reworked “21st Century Cures Act” released over the holiday weekend by House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN). The Cures Act will be combined with a scaled down version of mental health reform legislation, an ACEP priority in the 114th Congress.

    Click here to contact your U.S. Representative by email.

    The $6.3 billion Cures Act includes language to streamline FDA approval of some devices and creates guidance for regulating products that are a combination of drugs and devices. And, as now proposed includes many additional provisions from other health care bills introduced in this Congress including funding for President Obama's precision medicine initiative, the cancer "moonshot" effort and Alzheimer's research. The act creates innovation accounts for the NIH and FDA that would be replenished annually.

    The sweeping legislation also includes the following ACEP priorities:

    • Provisions that will ensure electronic health record (EHR) technologies are capable of sharing data with clinician-led clinical data registries (such as ACEP’s Clinical Emergency Data Registry), including authority for the HHS Inspector General to investigate and take enforcement action against improper data blocking by EHR technologies;
    • Nearly $5 billion in additional funding for the National Institutes of Health (NIH) to advance medical research and treatments;
    • Comprehensive mental health reforms that expand inpatient and outpatient services for individuals with serious mental illness and the establishment of a new assistant secretary for mental health in HHS; and
    • $1 billion in state grants to address the opioid epidemic.

    Advocates for the Cures Act have been pushing for action in the lame duck session before President-elect Donald Trump enters the White House and begins work on his own priorities.

    With the likelihood that large parts of the ACA will be repealed, the Cures Act will be funded with some money from the ACA, and some to be generated by sales of part of the Strategic Petroleum Reserve.

    Send this letter today to urge your U.S. Representative to vote “Yes” for the 21st Century Cures Act.

    Please contact Gabrielle Szlenkier via email or phone at (202) 370-9300 if you're having trouble accessing the ACEP Advocacy website.

  • Weekly Update, November 17, 2016

    The U.S. House and Senate returned to D.C. on Monday to begin the final lame-duck session of the 114th Congress. Both chambers will be in recess next week for Thanksgiving. Congress will return after the holiday for the final couple of weeks before Congress adjourns for the remainder of the year. Capitol Hill Republicans are nearing consensus on how they would like to fund the government past December 9, but whether a funding agreement will be a short-term continuing resolution or a more broad omnibus measure remains to be seen.

    In this issue:

    • EMS Standing Orders Bill Passes the House
    • ACEP President Discusses Opioid Abuse
    • VA Emergency Medicine Issues on the Hill
    • ACEP Fair Coverage Campaign Goes Viral
    • Make Your Voice Heard – Register for ACEP Leadership & Advocacy Conference

    House Approves EMS Standing Orders Bill
    As reported in the 911 Network Special Alert on Monday, the House unanimously approved ACEP-supported legislation that will ensure continued access to pain and anti-seizure medications for patients suffering medical emergencies. The "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 4365), sponsored by Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC), was one of the priority issues ACEP members promoted during Leadership and Advocacy Conference 2016. The legislation will explicitly permit physician medical directors to issue standing orders to EMS personnel so they may administer controlled substances to their patients. In addition, the legislation clarifies and codifies who is authorized to provide verbal orders for controlled substances; provides the option for a single EMS agency registration; and clarifies receipt, movement and storage rules for EMS agency controlled substances.

    We are working with Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO) to move the same or similar legislation through the Senate as quickly as possible so that it can be sent to the president's desk before the end of the year.

    ACEP President Speaks to Attorneys General About Opioids
    On Tuesday, ACEP President Becky Parker, MD, FACEP, participated in a discussion about opioid use, misuse and treatment during the 2016 National Attorneys General Training and Research Institute. In addition to Dr. Parker, the panel included a person in recovery, a practicing psychiatrist and a representative of the Department of Justice. Dr. Parker's remarks focused on the human impact opioid misuse and illicit synthetic drugs are having on individuals, families and communities and she promoted ACEP's role in working to find solutions to this epidemic. To view additional information about ACEP's work to curtail opioid misuse, please visit our opioid resources website.

    Surgeon General Report on Addiction
    Today, U.S. Surgeon General Vivek H. Murthy published a report on the health crisis impacting several communities across the country. “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” is a comprehensive review of the science of substance use, misuse, and disorders. The report is available online at https://addiction.surgeongeneral.gov.

    ACEP Members Promote VA Emergency Medicine Issues with Key Members of Congress
    On Wednesday, ACEP Government Services Chapter President Chad Kessler, MD, MPHGS, FACEP, and ACEP member Lance Scott, MD, both of whom work at VA medical centers, met with several lawmakers who serve on the House Veterans Affairs Committee or Senate Veterans Affairs Committee to discuss the evolving role of VA emergency medicine. Participating in ACEP's Leader Visit Program, Dr. Kessler and Dr. Scott had a full day of meetings with key Members of Congress and their staffs that included Rep. Gus Bilirakis (R-FL), Rep. Mike Coffman (R-CO), Dr. Phil Roe (R-TN), Rep. Mark Takano (D-CA), Dr. Raul Ruiz (D-CA), Sen. Johnny Isakson (R-GA), Sen. Richard Blumenthal (D-CT) and Sen. Mazie Hirono (D-HI).

    Message From ACEP’s President, Dr. Becky Parker: Please Share Our Video and Help It Go Viral!
    You've probably seen the multi-million dollar ad campaign Cigna Insurance is airing using “TV doctors.” ACEP has produced a parody version starring ACEP members to drive home the message that we provide real, life-saving care for our patients – unlike insurance companies. This is part of our ongoing Fair Coverage campaign aimed at the insurance industry and its ever-shrinking reimbursements for emergency care. (For more, visit www.faircoverage.org.) Help this video go viral! We do not have Cigna’s $9 million budget but we think ACEP members and their friends and families can help by posting links to Facebook, sharing via email and tweeting about it - #FairCoverage

    ACEP Leadership & Advocacy Conference – Mark your calendar!
    With a new Administration, Congress, and legislative agenda, the need for your involvement is greater than ever before. Please join your colleagues and emergency medicine leaders from across the country at ACEP’s 2017 Leadership and Advocacy Conference, March 12-15, 2017. For further details about the meeting and to register, please click here.

  • Network Special Alert, November 14, 2016

    House Passes EMS Standing Orders Legislation during Lame Duck Session

    Today, on the first day of the lame duck session following the national elections, the U.S. House of Representatives unanimously approved ACEP-supported legislation that will ensure continued access to pain and anti-seizure medications for patients suffering medical emergencies. ACEP, NAEMSP and NAEMT have been working to enact this legislation since the beginning of the 114th Congress (January 2015). Enacting this legislation was one of three priority issues ACEP members promoted during LAC 2016 and Dr. Craig Manifold testified in favor of the bill before the House Energy and Commerce Health Subcommittee on July 12, 2016.

    The "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 4365), sponsored by Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC), will explicitly permit physician medical directors to issue standing orders to EMS personnel so they may administer controlled substances to their patients. In addition, the legislation clarifies and codifies who is authorized to provide verbal orders for controlled substances; provides the option for a single EMS agency registration; and clarifies receipt, movement and storage rules for EMS agency controlled substances.

    We are working with Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO) to move the same or similar legislation through the Senate as quickly as possible so that it can be sent to the president's desk before the end of the year.

    We had great support from other members of the emergency medicine community in this effort, including: Air Medical Physician Association, American Academy of Pediatrics, American Ambulance Association, American Association of Orthopaedic Surgeons, American Trauma Society, Association of Air Medical Services, Association of Critical Care Transport, Emergency Nurses Association, Epilepsy Foundation, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of State EMS Officials, Orthopaedic Trauma Association and Paramedic Foundation.

  • Weekly Update, November 11, 2016

    Both Chambers will be in session next week.

    In this issue:

    • Lame Duck Session
    • Future of ACA
    • What’s Ahead in Next Congress
    • ACEP Advocacy Continues

    Lame Duck Session
    After a tumultuous election, the House and Senate will reconvene next week to begin the lame duck session which is scheduled to last through mid-December. Must-pass agenda items are an extension of funding for federal agencies and programs beyond the Dec. 9 deadline, an annual defense policy bill and renewing the Iran Sanctions Act. Congressional leadership elections will also take place next week. ACEP is still working on several outstanding issues we would like to see addressed before the end of the year, including legislation that would:

    • Promote comprehensive reforms and expand services for patients with serious mental illness (H.R. 2646/S. 2680);
    • Codify the use of standing orders so that EMS personnel may continue to administer controlled substances (H.R. 4365/S. 2932);
    • Allow flexibility in scheduling shifts for emergency physicians who work full-time for the VA (H.R. 4150/S. 1450);
    • Provide grants to train first responders and others on how to identify and respond to individuals with mental illness and substance use disorders (H.R. 1877/S. 711); and
    • Add 22 illicit synthetic substances to Schedule I of the Controlled Substances Act (H.R. 3537).

    Future of ACA
    This week President-elect Trump met with both House and Senate Republican leadership to discuss some of their immediate priorities. Not surprisingly one of those items is repealing and replacing Obamacare. When and how they address this issue remains to be seen. In the post-election light, Donald Trump has relaxed some of his original campaign rhetoric on outright repeal and indicated a willingness to maintain some of the core pillars of the healthcare law.

    Full repeal of the health law is complicated, however they do have a roadmap to replace major parts of the law – probably enough to make it unworkable. Republicans could use a technical budget tool called reconciliation, which doesn’t allow a filibuster. The repeal plan would have to go through an elaborate review to make sure it complies with intricate budget rules and Democrats can challenge the results. But the GOP is still far apart on specifically what kind of alternative to enact. Trump and House Speaker Paul Ryan have given only broad outlines of what that replacement would look like. They’re relatively similar plans: Individuals would get tax credits to help them buy insurance, tax-favored Health Savings Accounts would be encouraged, and insurers would be allowed to sell policies across state lines.

    ACEP’s Government Affairs team in Washington, DC will be providing a more comprehensive look at the direction of the ACA and health care policy overall in the 115th Congress in the near future.

    115th Congress – What’s Ahead
    While most of the class of freshman lawmakers elected on Nov. 8 will not begin their term until January 2017 when the 115th Congress convenes, these new members will be in Washington, DC next week for orientation. There are six new Senators (seven after the run-off in LA on Dec. 10) and at least 58 new House members (4 races remain uncalled). Leadership elections and committee chairmanships will also be decided during the lame duck.

    ACEP Advocacy with the New Congress
    As the 2016 congressional elections began to take shape, we heard from ACEP members around the country and from leaders in our state chapters about candidates in their states and home districts who were worthy of consideration by the NEMPAC Board of Trustees. More than 250 ACEP members hosted ED visits for congressional candidates to educate them on issues of particular concern to EM physicians and patients, interviewed and educated candidates, attended fundraisers in their home districts, and presented NEMPAC checks to candidates. NEMPAC supported 227 congressional candidates and 92.5% of NEMPAC-supported candidates were elected or re-elected to Congress. For more information on NEMPAC’s involvement in the 2016 elections, please go to www.acep.org/nempac.

    In the upcoming months before the 115th Congress convenes, ACEP staff in the Washington DC office will begin a campaign to meet as many newly elected members as possible and will be working to set up introductory meetings back home with ACEP members either through Emergency Department visits or more informal coffees. If you are interested in meeting with your Member of Congress in the next few months, please contact Jeanne Slade in the ACEP office at jslade@acep.org. We will provide you with talking points and materials to help you educate your legislator on issues of importance to emergency medicine.

  • Special Election Edition

    Donald Trump will be the next President of the United States, clinching several swing states, including Florida, North Carolina, Pennsylvania and Ohio. Republicans also swept the Capitol, maintaining control of both the House and Senate for the upcoming 115th Congress. ACEP's political action committee, the National Emergency Medicine PAC, supported nearly 250 pro-emergency medicine candidates this election cycle with a 92% success rate. Additional information on NEMPAC’s participation in the 2016 elections is available on the NEMPAC website.

    (NEMPAC does not support presidential candidates.)
    President (Electoral College Map)
    Trump wins with at least 279 votes (AK, AZ, MI, and NH undecided)*

    U.S. Senate
    Democrats gain one seat in Senate, but Republicans maintain majority (51 to 46; 2 Independents who Caucus with Democrats; 1 Race: LA - Undecided)*

    U.S. House of Representatives
    Democrats gain net 7 seats in House, but Republicans maintain majority (239 to 193; 4 races undecided: CA-07, CA-49, LA-03 and LA-04; LA-03 run-off has 2 Republicans)*

    Emergency Physician Candidates
    Three Emergency Physicians Ran for Election (1 in the Senate/2 in the House), but only 1 was successful:

    • Rep. Joe Heck (R-NV - Lost Bid for Nevada Senate Seat
    • Rep. Raul Ruiz (D-CA-36) - Re-Elected to House
    • Dr. Mark Plaster (R) - Lost Bid for House Seat in MD-03

    Other physician Members and Candidates
    Five of the 14 physician members of the House of Representatives gave up their seats. Two physicians retired, Reps. Dan Benishek (R-MI) and Jim McDermott (D-WA), and three chose to run for the U.S. Senate: Rep. Joe Heck (R-NV), Rep. Charles Boustany (R-LA) and Rep. John Fleming (R-LA). Of the three, none were successful.

    Eight physicians were re-elected to the House: Reps. Ralph Abraham (R-LA), Larry Bucshon (R-IN), Michael Burgess (R-TX), Scott DesJarlais (R-TN), Andy Harris (R-MD, Tom Price (R-GA), Phil Roe (R-TN), and Raul Ruiz (D-CA). Dr. Ami Bera's (D-CA) race in CA-07 is too close to call as of this writing.

    In the Senate, Sen. Rand Paul (R-KY) was re-elected and Sens. John Barrasso (R-WY) and Bill Cassidy (R-LA) will return as they were not up for re-election this cycle.

    Two physicians supported by NEMPAC were newly elected to Congress: Dr. Neal Dunn (R) in FL-02 and Dr. Roger Marshall (R) in KS-01. So, the new Congress that convenes in January will have 13 physician members (possibly 14 if Dr. Bera is successful).

    Three dentists were re-elected to the House of Representatives: Reps. Brian Babin (R-LA), Paul Gosar (R-AZ) and Mike Simpson (R-ID) and one dentist was newly elected, Drew Ferguson (R), in GA-03.

    For more detailed information, we suggest the following websites:

    Roll Call

    Politico

    CNN

    Fox News

    MSNBC

    New York Times

    Washington Post

    Stay tuned for additional analysis by ACEP of the upcoming lame-duck session and outlook for the 115th Congress.

  • Weekly Update, September 30, 2016

    In this issue:

    • Government Avoids Shutdown
    • House Approves ACEP-supported Bills
    • EMS Standing Orders Legislative Update
    • ACEP Member Promotes Telemedicine on Capitol Hill

    Congressional Schedule
    House and Senate are in recess until after the November elections.

    Government Avoids Shutdown
    The House and Senate this week approved a 10-week continuing resolution (CR) to keep government agencies and programs funded through Dec. 9. The CR was approved by the House on Wednesday night (342 to 85) and earlier in the day by the Senate (72 to 26).

    The CR was needed because none of the 12 annual appropriations bills had been signed into law and the fiscal year 2017 begins Saturday. In addition to the stopgap funds, the package provides:

    • $82.5 billion in FY 17 Military Construction-Veteran Affairs discretionary spending,
    • $1.1 billion to combat the Zika virus outbreak,
    • $500 million for flood relief in Louisiana and other states, and
    • $7 million for opioid programs authorized in the Comprehensive Addiction and Recovery Act (CARA) that was recently signed into law.

    House Approves Synthetic Drug and Mental Health Bills
    On Monday, the House approved the ACEP-supported "Dangerous Synthetic Drug Control Act" (H.R. 3537) by a vote of 258 to 101. The bill, sponsored by Reps. Charlie Dent (R-PA) and Jim Himes (D-CT), will place an additional 22 compounds, including several illicit synthetic fentanyl substances, on Schedule I of the Controlled Substances Act. These substances were identified by the DEA as especially dangerous and were selected after a lengthy review by FDA, NIH, ONDCP and outside researchers.

    The other ACEP-supported bill, the "Mental Health First Aid Act" (H.R. 1877), sponsored by Reps. Lynn Jenkins (R-KS) and Doris Matsui (D-CA), was approved by voice vote. This legislation authorizes grants to train first responders, prison guards and others on how to identify, understand and respond to signs of mental illness and substance use disorders.

    EMS Standing Orders Legislation Update
    ACEP and its coalition of provider, patient advocacy and health care organizations were working with our House and Senate sponsors, Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC) and Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO), this week trying to get Congress to consider this important legislation before it left town for the recess. After the Energy and Commerce Committee approved H.R. 4365 last week by voice vote, we had hoped to get the House to consider their bill under expedited procedures this week. Unfortunately, we needed another committee to discharge the bill first. We had simultaneously been working with the Senate to get approval by unanimous consent (UC), but the bill wasn’t released in time for Senate consideration before they left town. Both bills should be primed for action in their respective chambers when Congress returns after the elections.

    ACEP Member Promotes Telemedicine with Key Members of Congress
    On Wednesday, ACEP member Dr. Robert Galli, Professor and Medical Director of TelEmergency at the University of Mississippi Medical Center, met with several federal lawmakers to discuss how emergency telemedicine services can positively impact patient care in both rural and urban areas, as well other key issues, such as reimbursement and generating cost savings, treating patients with mental health/substance use issues and support for Critical Access Hospitals (CAHs). Participating in ACEP's Leader Visit Program, Dr. Galli had a full day of meetings and fundraisers with Members of Congress, their staffs and other interested parties that included the AMA, Sen. John Thune (R-SD), Sen. Ben Cardin (D-MD), Sen. Brian Schatz (D-HI), Sen. Thad Cochran (R-MS), Sen. Lisa Murkowski (R-AK), Rep. Diane Black (R-TN), Rep. Glen Thompson (R-PA), Rep. Erik Paulsen (R-MN), Rep. Greg Harper (R-MS) and Sen. Chuck Schumer (D-NY).


    ACEP member Dr. Robert Galli met with legislators Senator Chuck Schumer (D-NY), Congressman Gregg Harper (R-MS), and Congressman Mike Thompson (R-PA) to discuss telemedicine issues

  • Weekly Update, September 23, 2016

    Both chambers will be in session next week.

    In this issue:

    • Senate Republicans Release Government Funding Proposal
    • ACEP Member Testifies on Rising Cost of Opioid Medications
    • EMS Standing Orders Bill Advances in the House
    • Other Action on ACEP-supported Legislation
    • Recent ED Visits for Legislators hosted by 911 Network Members

    Senate GOP Releases Funding Proposal
    On Thursday, Senate Republicans released a short-term funding proposal that would continue federal operations through Dec. 9. The spending measure includes some bipartisan provisions such as $1.1 billion to address the Zika virus, $37 million to confront opioid abuse and $500 million to help victims of flooding in Louisiana, West Virginia and Maryland. Republicans said that the new opioid funding would give a head start to establish programs from the recently passed, ACEP-supported Comprehensive Addiction and Recovery Act (CARA), thus preventing the need to wait until the longer-term spending bill is considered in December. These provisions and the funding are fluid as the two parties continue to negotiate what will be included in the final legislative package. One sticking point in the current negotiations is Democrats insistence that funding be included to assist victims of the Flint water crisis.

    ACEP Member Testifies Before House Judiciary Committee
    On Thursday, ACEP member Dr. Eric Ketcham testified before the House Judiciary Regulatory Reform Subcommittee regarding the rising costs of certain opioid medications. Specifically, Dr. Ketcham discussed the role naloxone and buprenorphine play in providing care to opioid overdose and addiction patients and how these cost increases have affected availability. Witnesses representing the Pharmaceutical Research and Manufacturers of America (PhRMA), Generic Pharmaceutical Association (GPhA), Pharmaceutical Care Management Association and UC Hastings College of Law also testified. To view the hearing or to read the testimony, click here.


    ACEP member Dr. Eric Ketcham before the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law

    House Committee Advances EMS Standing Orders Bill
    On Wednesday, the House Energy and Commerce Committee passed several ACEP-supported bills, including the legislation to codify the use of standing orders for EMS personnel. ACEP has been working on the "Protecting Patient Access to Emergency Medications Act" (H.R. 4365) since the Drug Enforcement Administration (DEA) first notified us about their plans to prevent the administration of controlled substances by EMS personnel at ACEP14. ACEP and NAEMSP have led the coalition of nearly 20 health care, first responder and patient advocacy organizations as we have worked to enact this vital legislation before the end of the current congressional session, which concludes in December. The committee approved H.R. 4365 by voice vote. With only a few legislative days remaining before the House and Senate recess until after the national elections in November, it is uncertain if this legislation will be considered by the full House until the lame-duck session. However, ACEP did reach out to House Majority Leader Kevin McCarthy (R-CA) to request that the legislation be put on next week’s calendar for a vote. H.R. 4365 currently has 133 bi-partisan co-sponsors. The most recent additions include Reps. Kathleen Rice (D-NY) and David Schweikert (R-AZ).

    On a related note, the Senate HELP Committee delayed its approval of the counter-part bill, S. 2932, which was scheduled to occur on Wednesday. The postponement of the committee mark-up was unrelated to this legislation. The bill's sponsors, Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO), are working with the Senate leadership to expedite its consideration. S. 2932 currently has 12 bi-partisan co-sponsors with Sens. Heidi Heitkamp (D-ND) and John Hoeven (R-ND) adding their support this week.

    Other Bills Advancing in the House
    The other ACEP-supported bills that were approved by their respective committees of jurisdiction this week include:

    • H.R. 1877, the “Mental Health First Aid Act,” introduced by Reps. Lynn Jenkins (R-KS) and Doris Matsui (D-CA). The legislation requires SAMHSA to award grants to initiate and sustain mental health awareness training programs for first responders, law enforcement and teachers. The goal of these programs is to train individuals to accomplish safe de-escalation of crisis situations, recognize the signs and symptoms of mental illness, and encourage timely referral to mental health services.
    • H.R. 3537, the “Synthetic Drug Control Act of 2015,” introduced by Rep. Charlie Dent (R-PA). The revised bill would add 22 illicit synthetic compounds to Schedule I of the Controlled Substances Act (CSA).
    • H.R. 4150, the "Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act," sponsored by Reps. Raul Ruiz (D-CA) and Brad Wenstrup (R-OH). This bill would provide flexibility in the hours VHA emergency physicians and physician assistants work every two weeks provided the total hours do not exceed the annual limit.

    House Members Urge Senate Action on Mental Health Reform
    In July, the House passed H.R. 2646, the “Helping Families in Mental Health Crisis Act,” ACEP- supported legislation that was promoted during ACEP’s Leadership and Advocacy Conference in May. Now, 211 House members are urging Majority Leader Mitch McConnell (R-KY) and Minority Leader Harry Reid (D-NV) to bring the House-passed legislation up for a vote in the Senate.

    “Given the urgency of the mental health crisis in America, we write with the vital request that the Senate take up and pass the Helping Families in Mental Health Crisis Act before you break for the district work period,” they write in a letter released Friday. The Senate is scheduled to be in session through the first week of October, but is expected to adjourn as soon as the chamber passes a stopgap spending measure (see above) that will keep the government funded through Dec. 9.

    The Senate is also considering its own mental health legislation, which is caught up in a fight over gun rights, but could come up for a vote during Congress’s lame duck session after the election if an agreement is reached. If each chamber passed its own mental health bill, a conference committee could be convened to hammer out the details for a final bill.

    ACEP Members Host ED Visits for Legislators
    On Wednesday, Dr. Thomas Wyatt met with Megan Sharp, Outreach Director for Senator Amy Klobuchar’s (D-MN), at the Hennepin County Medical Center Emergency Department in Minneapolis, Minnesota.

    ACEP 911 Network members continue to host legislators and their staff at local emergency departments across the country. If you are interested in hosting or have photos from recent visits, please contact Jeanne Slade, ACEP’s Director of Political Affairs.

  • Weekly Update, September 16, 2016

    Funding the Government Cont’d…
    Both chambers will be in session next week. The House and Senate will continue to negotiate a short-term spending bill that will fund the federal government beyond the expiration of the current fiscal year, which ends on Sept. 30. Contentious policy issues surrounding funding for the Zika virus continue to cloud the debate, as well as determining what other programs will be included in the package, such as Louisiana flood relief.

    In this issue:

    • Bicameral Momentum for ACEP-Supported EMS Standing Orders Bill
    • Mental Health First Aid Bill Advances
    • ACEP Testimony on Drug Pricing and Availability
    • Technology and Innovation in Healthcare Hearing
    • Upcoming Hearings
    • Latest ED Visits by Legislators
    • ACEP Headquarters Grand Opening in Irving, Texas

    EMS Standing Orders Bill Advancing in both Chambers
    Next week, both the House Energy and Commerce Committee and the Senate HELP Committee will mark-up the ACEP-supported "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 4365/S. 2932), sponsored by Reps. Richard Hudson (R-NC), G.K. Butterfield (D-NC), Blake Farenthold (R-TX) and Steve Cohen (D-TN) and Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO), respectively. The bill would amend the Controlled Substances Act to enable paramedics and other emergency medical services (EMS) professionals to continue to administer controlled substances to patients pursuant to standing orders issued by their EMS agency’s medical director. ACEP has worked closely with both the House and Senate to build awareness and support for the legislative proposal. Currently, H.R.4365 has 129 cosponsors and S. 2932 has ten bi-partisan co-sponsors. The most recent additions include Reps. Charlie Dent (R-PA), Cheri Bustos (D-IL), Dan Lipinski (D-IL), Joe Courtney (D-CT) and Sen. Roy Blunt (R-MO). The House Energy and Commerce Subcommittee on Health advanced the bill this week by voice vote.

    Mental Health First Aid Bill Advances
    Also during Wednesday’s House Energy and Commerce Subcommittee on Health mark-up, the committee advanced another ACEP-supported bill. H.R. 1877, the “Mental Health First Aid Act,” introduced by Reps. Lynn Jenkins (R-KS) and Doris Matsui (D-CA). The legislation requires SAMHSA to award grants to initiate and sustain mental health awareness training programs for first responders, law enforcement and teachers. The goal of these programs is to train individuals to accomplish safe de-escalation of crisis situations, recognize the signs and symptoms of mental illness, and encourage timely referral to mental health services.

    ACEP Witness Scheduled to Testify Before House Committee
    On Thursday, ACEP member Dr. Eric Ketcham is scheduled to testify before the House Judiciary Regulatory Reform Subcommittee regarding the rising costs of certain opioid medications. Specifically, Dr. Ketcham will be discussing the role naloxone and buprenorphine play in providing care to opioid overdose and addiction patients and how these cost increases have affected availability.

    House Ways and Means Talks Technology in Healthcare
    On Wednesday, the House Ways & Means Health Subcommittee held a hearing titled, “Exploring the Use of Technology and Innovation to Create Efficiencies and Higher Quality in Health Care.” Several issues were discussed during the hearing from palliative care, burdensome meaningful use requirements, workforce shortage reductions, access to care, incentivizing innovations and reimbursements, as well as improving secure data flow and elimination of data blocking. Of particular note Chairman Pat Tiberi (R-OH) referenced his visits to the Ohio Medical Center and specifically spoke about the technologies being implemented in the Emergency Department to increase efficiencies and track available beds. The recent hearing is likely the last Ways and Means Health Subcommittee hearing for the year, but the committee plans to hold similar hearings next year. To learn more about the hearing please click here.

    Upcoming Hearings
    9/20 – Senate Health, Education, Labor and Pensions Committee hearing titled “Laboratory Testing in the Era of Precision Medicine.” To learn more click here.

    9/21 – Senate Health, Education, Labor and Pensions Committee markup of S.2873, the "Expanding Capacity for Health Outcomes (ECHO) Act;" S.2932, the "Protecting Patient Access to Emergency Medications Act of 2016;" and the "Career and Technical Education Act of 2016.” To learn more click here.

    Recent ED Visits by Legislators
    ACEP’s active 911 Network continues to host Congressional representatives at local emergency departments across the country. If you are interested in hosting or have photos from recent visits, please get in touch by emailing Jeanne Slade.

    ACEP Members Host ED Visits for Legislators
    ACEP’s active 911 Network continues to host Congressional representatives at local emergency departments across the country. If you are interested in hosting or have photos from recent visits, please get in touch by emailing Jeanne Slade.


    Dr. Raul Ruiz (D-CA), a board certified emergency physician, recently visited the Carolinas Healthcare - Lincoln Hospital hosted by Dr. Brad Watling, System Medical Director for US Acute Care.


    ACEP Board Members and staff at the grand opening of ACEP headquarters in Irving, TX

  • Weekly Update, September 9, 2016

    Congress Returns for Funding Fight
    Congress returned to Washington this week after a seven week break to hash out an agreement on funding the government before the end of the month. Working under a tight schedule, House Republicans are struggling to reach consensus within their own party on funding terms.

    While Congress could simply pass a sweeping continuing resolution (CR) that would extend fiscal 2016 funding levels across the government, some members are pushing for a deal that would finalize one or more individual appropriations bills and use a CR for the remaining agencies. Questions remain on whether to add supplemental funding for anti-Zika efforts and Louisiana flooding relief aid.

    It is expected that the Senate will pass their version of the stopgap funding measure late next week and then possibly adjourn and return to their states to campaign leaving the House to finalize the funding measure. Other big ticket items such as mental health reform and response to gun violence issues remain in limbo and are likely to be pushed until after the election.

    In this issue:

    • ACEP Supported EMS Standing Orders Bill Advancing
    • Update on Legislative Efforts to Combat Substance Abuse
    • CMS Announces New Options for MACRA Participation
    • Recent and Upcoming Hearings
    • ED Visits during the Congressional Recess
    • ACEP Supported Bills Gain Additional Co-Sponsors

    EMS Standing Orders Bill Poised to Advance in House
    On Monday and Tuesday of next week the House Energy and Commerce Subcommittee on Health will mark-up several bills, including the ACEP-supported "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 4365), sponsored by Reps. Richard Hudson (R-NC), G.K. Butterfield (D-NC), Blake Farenthold (R-TX) and Steve Cohen (D-TN). The bill would amend the Controlled Substances Act to enable paramedics and other emergency medical services (EMS) professionals to continue to administer controlled substances to patients pursuant to standing orders issued by their EMS agency’s medical director. ACEP has worked with both the House and Senate to build awareness and support for the legislative proposal. Currently, H.R.4365/S.2932 has 127 cosponsors in the House and nine in the Senate. The Senate HELP Committee is expected to mark up the legislation the week of September 19th.

    Substance Abuse Legislation
    The opioid legislation (aka “Comprehensive Addiction and Recovery Act” or CARA for short) was signed into law on July 22. Policy-wise, the bill includes almost all of the principles ACEP shared with Congress regarding what we wanted to see included in the opioid/pain management legislation. ACEP, like most advocacy groups involved with this issue, wanted to see Congress dedicate more money as part of the bill to ensure certain programs will be effective and successful in addressing the substance abuse crisis. For example, CARA proposed expanding the number of pill disposal sites, but no direct funding was provided in the bill. However, Republicans believe they can accomplish additional funding for the bill’s provisions through the annual appropriations process. ACEP’s focus going forward will be on ensuring these programs do actually obtain appropriate funding to make them viable.

    Additionally, this week Sens. Rob Portman (R-OH), Kelly Ayotte (R-NH) and Ron Johnson (R-WI) unveiled the "Synthetics Trafficking and Overdose Prevention (STOP) Act."  The proposal aims to prevent two illicitly manufactured synthetic opioid drugs, the prescription painkiller fentanyl and the tranquilizer carfentanil, from entering the United States in an effort to stem the country’s opioid misuse epidemic. The legislation focuses on curbing the drugs’ imports from China and India by requiring additional electronic customs data for foreign shipments into the United States using the U.S. Postal System. Other major carriers like UPS and FedEx already follow these requirements.

    Flexibility on MACRA
    Yesterday, CMS announced that it will give providers new options for the pace and level at which they comply with payment reforms required under the Medicare Access and CHIP Reauthorization Act. Under the new terms, there will be four compliance options for providers which include participating for part of the calendar year, participating for the full calendar year, participating in an advanced alternative payment model next year, and participating in a test of the quality payment program. CMS is expected to issue a final rule implementing these reforms on November 1st.

    Recent Hearings
    Earlier today the House Energy and Commerce Subcommittee on Health held a hearing titled “An Examination of Federal Mental Health Parity Laws and Regulations.” To view the hearing, click here.

    On Tuesday, House Committee on the Budget held a hearing titled “Center for Medicare and Medicaid Innovation: Scoring Assumptions & Real-World Implications;” a list of witnesses can be found here.

    On Tuesday, House Committee on Veterans’ Affairs held a hearing titled “From Tumult to Transformation: The Commission on Care and the Future of the VA Healthcare System;” additional information can be found here.

    Also on Tuesday, House Ways and Means Health Subcommittee held a hearing titled, “The Evolution of Quality in Medicare Part A;” more information can be found here.

    On Thursday, the House Energy and Commerce Subcommittee on Health held a hearing titled “Examining Legislation to Improve Public Health,” which included H.R. 3119, the Palliative Care and Hospice Education and Training Act (PCHETA); details can be found here.

    Upcoming Hearings
    9/12 – House Energy and Commerce Subcommittee on Health will markup of H.R. 4365, "Protecting Patient Access to Emergency Medications Act of 2016;" H.R. 1192, "National Diabetes Clinical Care Commission Act;" H.R. 1209, "Improving Access to Maternity Care Act;" H.R. 2713, "Title VIII Nursing Workforce Reauthorization Act of 2015;" and the ACEP-supported "Mental Health First Aid," H.R. 1877, which would provide grants to train first responders and others how to respond to the individuals suffering from mental illness or substance abuse. Click here for details.

    9/14 – House Energy and Commerce Subcommittee on Health will hold a hearing titled, “The Affordable Care Act on Shaky Ground: Outlook at Oversight.” More information can be found here.

    9/14 – House Ways and Means Health Subcommittee will hold a hearing titled “Exploring the Use of Technology and Innovation to Create Efficiencies, Higher Quality, and Better Access for Beneficiaries in Health Care.” Additional details here.

    ACEP Members Host ED Visits for Legislators during the Congressional Recess
    Several members of the ACEP 911 Legislative Network hosted emergency department visits for their legislators during the recess including:

    • Dr. Will Scruggs hosted Rep. Tulsi Gabbard (D-HI) in the Wahiawa ED on 7/14
    • Drs. Christian Coletti and John Powell hosted congressional candidate Sean Barney (D-DE) in the Wilmington Hospital ED on 7/15
    • Dr. Andrew Pacitti hosted Rep. Andy Barr (R-KY) in the Marcum and Wallace Hospital ED on 7/20
    • Dr. Tom Charlton hosted Rep. Brad Wenstrup (R-OH) on 7/27
    • Dr. Rawle Seupaul hosted Rep. French Hill (R-AR) at the UAMS ED in Little Rock on 8/2
    • Dr. Hamad Husainy hosted Rep. Mo Brooks (R-AL) on 8/9
    • Dr. Jack Kelly hosted Brad Grantz, legislative director for Sen. Pat Toomey (R-PA), in the Einstein Medical Center in Philadelphia on 8/11


    Dr. Michael Repplinger with Rep. Mark Pocan (D-WI) ---- Dr. Andy Bern with Rep. Ted Deutch (D-FL)

    Please share any photos you have with legislators to be featured by emailing Jeanne Slade.

    Additional Co-Sponsors for ACEP-Supported Bills

    • The "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) introduced by Rep. Charlie Dent (R-PA) and Senator Roy Blunt (R-MO), which addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who perform EMTALA-related services with temporary protections under the Federal Tort Claims Act, continues to garner congressional support. Since last reported, additional Members of Congress have been added bringing the total co-sponsorship in the House to 110 and nine in the Senate. The most recent additions include: Rep. French Hill (R-AR).
    • The “Protecting Patient Access to Emergency Medications Act” (H.R. 4365/S. 2932) introduced by Reps. Hudson, Butterfield, Farenthold and Cohen, and Sens. Bill Cassidy (R-LA) and Mike Bennet (D-CO), which seeks to streamline the ability for EMS care providers to receive, move, store and administer controlled substances. Since ACEP’s Hill visits in May, the legislation has received significant bi-partisan support, bringing the overall total co-sponsorship in the House to 127 and nine in the Senate. The most recent additions include: Sens. Jeff Flake (R-AZ), Pat Roberts (R-KS) and Jerry Moran (R-KS), as well as Rep. Chris Stewart (R-UT).
  • 2016 Convention Issue

    ACEP Leaders Attend 2016 National Party Conventions
    To advance the footprint of emergency medicine in the national political scene in this critical election year, ACEP’s President and President-elect recently participated in the 2016 Democratic and Republican national conventions. Although ACEP does not endorse Presidential candidates, our presence at both conventions offered ACEP leaders and staff exclusive access to members of Congress and their staffs, as well as national Republican and Democratic leaders, and valuable opportunities to network with key health care policymakers and professionals.

    ACEP President-elect Rebecca Parker, MD, FACEP, attended the Republican Convention on July 18 – 21 in Cleveland, OH, while ACEP President Jay Kaplan, MD, FACEP, attended the Democratic National Convention from July 25 – 28 in Philadelphia, PA. During the conventions, in addition to nominating their respective candidates for President and Vice President, Democrats and Republicans adopted their official party platforms.  


    NRCC Chairman Greg Walden (R-OR) with Dr. Parker at the RNC.


    Dr. Parker with Rep. Andy Barr (R-KY) at the RNC.

    Rep. Steny Hoyer (D-MD) with Dr. Kaplan at the DNC.


    Rep. Xavier Becerra  (D-CA) with Dr. Kaplan at the DNC. 


    Dr. Kaplan overlooking the DNC stage. 


    The view from the DNC. 

    Many of the opportunities provided at the conventions were a direct result of the clout of ACEP’s political action committee, the National Emergency Medicine PAC. NEMPAC is one of the top medical PACs in the country and consistently raises $2 million per election cycle from ACEP members to assist the campaigns of federal candidates. Our PAC has provided ACEP members with many opportunities to educate candidates about emergency medicine’s priorities and has helped elect legislators who will work to support issues important to ACEP and our patients.

    NEMPAC, along with eight other physician specialty and dentist organizations, co-hosted physician community receptions at both Conventions. The events offered a watch lounge for delegates and other attendees to stay up-to-date on important convention coverage, as well as live entertainment. Invitations were extended to all members of Congress and key staff members.

    If you have not yet made your annual contribution to NEMPAC, now is the time to join thousands of your ACEP colleagues to elevate the voice of emergency medicine in this critical election year. There are tremendous changes occurring in our health care system, and we need the combined voices of all 35,000 ACEP members across the country to ensure that support for and access to emergency care remains a top priority in Congress in 2016 and beyond. To learn more or to get more involved with NEMPAC, visit www.acep.org/NEMPAC (login: ACEP username and password), or contact NEMPAC staff at 202-727-0610, ext.3013.

    Health Care Platforms at the RNC and DNC

    DNC Platform Looks to Past to Build on Future
    Throughout the convention, speakers referenced Secretary Clinton’s past work on health care, notably her work as first lady to launch the Children’s Health Insurance Program after failing to advance legislation that would create universal health care at the beginning of the Clinton administration. Democrats also looked forwardto building on the Affordable Care Act and extending health coverage to more Americans.

    The final version of the official Democratic Party’s platform adopted a few weeks prior to the Convention includes an expansion of state ACA waivers and a commitment to repeal the health care law's Cadillac tax. It calls for scrapping the ACA’s excise tax on high-cost workplace health insurance plans and finding revenue to offset the massive cost of repeal.

    The platform also includes tackling prescription drug costs and preserving women's reproductive rights, including repeal of the Hyde Amendment. In addition, it includes language about the public option and increased funding for community health centers due to pressure from Sanders' campaign to move left.

    Health Care a Side Story at RNC
    Health care was not frequently discussed throughout the four-day affair in Cleveland. The GOP party platform was approved at the convention, and its health care proposals largely resemble the ideas put forth last month by House Republicans as part of their “Better Way” agenda. It calls for the full repeal of the Affordable Care Act and for state control of insurance markets. But repealing the 2010 health law was not a rallying cry as at the Convention as it has been among Republicans in recent elections. In fact, Trump called for its repeal just once during his remarks while going through a laundry list of broad policy-related goals.

    The platform backs selling insurance across state lines and suggests that insurance should be more portable so that consumers can move from job to job with the same policy. The party calls for block grants to Medicaid, state and federal legislation to cap non-economic damages in medical malpractice lawsuits, changes to the FDA that would speed drugs to market and new restrictions on fetal tissue donation. The platform states that block granting Medicaid is particularly needed to address mental health care.

    But it's also indicative of the gap between the party faithful and Trump on several key health care issues. For example it urges optional premium support in Medicare for future enrollees under 55 — despite Mr. Trump's promises to defend the program from cuts.

    There is no mention of allowing Medicare to negotiate drug prices, a policy idea that Trump had backed throughout the primary.

    Health care is likely to become a bigger topic in the campaign as both camps transition to the general election.

    Invite your Legislator for an ED Visit during the Congressional Recess
    Now that the Republican and Democratic Conventions have concluded, legislators will be home in their districts through Labor Day and will be looking for opportunities to meet with constituents and interest groups. We also anticipate a short legislative session in September, so they will have time in late September and October for site visits. Our ACEP advocacy team has successfully scheduled visits for the past several years with the assistance of Soapbox Consulting, which also handles scheduling for our Hill Visits during LAC.

    Please check the ACEP Advocacy website for more information and contact Jeanne Slade in the ACEP DC office for assistance.


    Rep. Lee Zeldin (R-NY) visits with Drs. Viccellio and Schiavone at Stony Brook Univ. Hospital in New York.

  • Congressional Recess Edition

    Congress is in recess and will return to business after Labor Day.

    When lawmakers come back in September, they'll have less than 20 working days to get things done with the main focus on a stopgap spending bill to keep the government open past Sept. 30. Most other big ticket items, such as Zika funding, mental health reform and any response to gun violence, are likely to get pushed back until after the election. In the interim, the Republican Convention will convene on July 18 in Cleveland, Ohio and the Democratic Convention will begin July 25 in Philadelphia, PA.
      
    In this issue:
    • ACEP Witness Testifies Before Congress
    • Senate Sends Opioid Legislation to President
    • Senate Finance Committee on MACRA
    • Appropriations Update
    • Host an ED Visit for your Legislator During the Congressional Recess

    ACEP Witness Testifies Before Congress
    On Tuesday, ACEP member and EMS Committee Chair Dr. Craig Manifold testified before the House Energy and Commerce Health Subcommittee regarding H.R. 4365, the “Protecting Patient Access to Emergency Medications Act of 2016,” which would codify the use of standing orders by EMS medical directors. The bill has garnered a total of 126 cosponsors in the House and seven in the Senate. The most recent additions include: Reps. Robert Brady (D-PA), Renee Ellmers (R-NC), Brett Guthrie (R-KY), Janice Hahn (D-CA) and Kristi Noem (R-SD), as well as Sens. Michael Bennett (D-CO) and Roger Wicker (R-MS.) To view the hearing, click here.


    Dr. Craig Manifold testifying before the House Committee on Energy & Commerce Subcommittee on Health

    Senate Sends Opioid Legislation to President's Desk
    On Wednesday, the U.S. Senate approved the final version of the "Comprehensive Addiction and Recovery Act" (CARA) – S. 524 – by a vote of 92 to 2. The formal House-Senate negotiations to finalize this opioid misuse legislation concluded last week and the U.S. House of Representatives overwhelmingly approved the package on Friday by a vote of 407 to 5. The legislation, which President Obama is expected to sign into law within a few days, includes several important ACEP-supported provisions that would:

    • Expedite training of military medics who become civilian emergency medical technicians (EMTs);
    • Improve access to opioid overdose reversal treatments, including grants to purchase and distribute naloxone to first responders, and expand physician co-prescribing of naloxone in conjunction with an opioid prescription for patients at an elevated risk of drug overdose;
    • Reauthorize grants to states to help them establish, implement and improve prescription drug monitoring programs (PDMPs);
    • Increase the number of disposal sites for unwanted prescription medications;
    • Allow more appropriately trained/supervised providers to dispense medication for maintenance or detoxification of narcotics;
    • Expand veteran drug/treatment courts that balance supervision, support and encouragement as alternatives to criminal incarceration;
    • Permit the partial filling of Schedule II controlled substances at the request of the patient or prescribing physician;
    • Require the Government Accountability Office (GAO) to conduct a study on Good Samaritan laws at the state level and efforts by the White House Office of National Drug Control Policy to address protections for prescribers or administers of naloxone, as well as those who call 911 to report an overdose;
    • Oblige Medicare programs to account for emergency medical situations when it requires a beneficiary to use one physician to write opioid prescriptions and one pharmacy to fill those prescriptions.

    To see the "Emergency Medicine Opioid Principles" that ACEP shared with U.S. Senators and Representatives this spring while Congress was developing the legislation, click here. Action on opioid legislation that included these key principles was one of the priorities shared by emergency physicians with federal lawmakers during ACEP's 2016 Leadership and Advocacy Conference in Washington, D.C. ACEP and other coalition partners are urging Congress to provide additional funding and resources for these programs through the annual appropriations process to ensure they are effectively implemented.

    Senate Finance Hearing on MACRA
    Also on Wednesday, the Senate Finance Committee convened a hearing entitled: "Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: Ensuring Successful Implementation of Physician Payment Reforms." Acting Administrator of CMS Andy Slavitt was the only witness. MACRA permanently repealed the flawed Sustainable Growth Rate (SGR) formula and implemented a Quality Payment Program (QPP) in its place. The two reimbursement pathways in the QPP are the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These new payment reforms are currently scheduled to take effect Jan. 1, 2017.

    In his testimony, Mr. Slavitt said CMS is concerned that some physicians, particularly at small practices, may not be ready for the changes and will struggle with the new rules. He then suggested MACRA implementation could be delayed, in accordance with recommendations made by ACEP and other medical groups in our comments to CMS on the proposed rule.

    To view ACEP's formal comments, click here. To view the hearing, click here.

    Appropriations Update
    For the second year in a row, the House Labor-HHS-Education Appropriations full committee approved its nearly $162 billion fiscal year 2017 appropriations (spending) bill, mostly along party lines (31 to 19). The legislative package is likely to become part of a House omnibus or continuing resolution when lawmakers return to Washington after the summer recess. The bill advanced out of committee despite objections from Democrats that it contains several "poison pill" policy riders, does not provide enough money for priorities like Zika, and cuts funding for CMS operations and family planning programs.

    Once again, the committee defeated amendments that would allow the CDC to conduct gun violence prevention research. However, ACEP was successful in its efforts to include report language similar to what was included in the Senate Labor-HHS-Education bill that would instruct CCIIO to publish additional information about how the agency establishes usual, customary and reasonable charges for insurance exchange out-of-network charges. The Senate Appropriations Committee approved its version of the Labor HHS spending bill in June. To view ACEP's chart comparing funding levels for key programs from both the Senate and House versions of the bill, click here.

    Host an ED Visit for your Legislator During the Congressional Recess 
    It's ACEP's goal, with your help, to build and strengthen ties with member of Congress in their home districts. The upcoming six-week congressional recess in an excellent time to invite your legislator to tour a local ED so he/she can see first-hand the challenges that emergency physicians face on a day-to-day basis in caring for their constituents. These meetings are often the start to a mutually beneficial relationship founded on trust, good information, and community ties.

    Please contact Jeanne Slade if you are interested in hosting an ED visit or meeting in the district. 

    Thank you to Dr. John Dayton and Dr. Alison Smith for recently hosting Congressman Chris Stewart (R-UT) at the University of Utah. 

    View photos of other ACEP members hosting visits in the ED Visit Gallery with your login credentials.

  • Weekly Update, July 10, 2016

    The House and Senate will be in session next week and will address several pressing issues before an extended recess period that begins at the end of the week prior to the Republican and Democratic Conventions. Congress will return to business in September after Labor Day.
      
    In this issue:
    • House Approves Mental Health Reform Bill
    • House Approves Opioid Bill
    • Appropriations Update
    • ACEP member to testify on EMS Standing Orders Bill

    House Approves Mental Health Reform
    On Wednesday, the U.S. House of Representatives overwhelming approved the ACEP-supported “Helping Families in Mental Health Crisis” bill (H.R. 2646) by a vote of 422 to 2. The only two dissenters were Reps. Justin Amash (R-MI) and Thomas Massie (R-KY).

    Of note to ACEP, the bill creates an Assistant Secretary for Mental Health and Substance Use Disorders and a National Mental Health Policy Lab, extends the Assisted Outpatient Treatment (AOT) grants, authorizes grant funding to create new Assertive Community Treatment teams (ACT), promotes telemedicine services, liability protections for volunteers at Community Health Centers and Community Behavioral Health Centers, expands the mental health workforce, clarifies HIPPA privacy rules for patients with mental illness and their caregivers, codifies the recently released IMD rule allowing for up to 15 days per month of inpatient psychiatric care for many Medicaid beneficiaries and expands efforts to implement mental health parity in health plans.

    ACEP has long supported meaningful mental health reform and this vote was a significant step forward as the nation desperately needs to establish policies and programs for individuals with serious mental illness. ACEP will continue to work with lawmakers to seek additional resources to fund these desperately needed services.

    At this time, it is unclear if the significant House vote will incentivize their Senate counterparts to advance their version of mental health reform, but, with only one week left before Congress adjourns for the national conventions and summer recess, no action is expected until at least September.

    House Approves Opioid Bill
    On Friday, the House approved the final version of the ACEP-supported “Comprehensive Addiction and Recovery Act” (CARA) – S. 524 by a vote of 407-5. The formal House-Senate Conference Committee met last Wednesday to reconcile differences between the House and Senate opioid bills. Major points of contention continued to be disagreements over adding new emergency funding for the bill’s opioid programs and the lack of additional funding overall. For this reason, no Democrat conferees agreed to the final report and the White House has also expressed concerns. Ultimately, Republicans prevailed in preventing new emergency funding for the legislation but agreed to provide money through the regular appropriations process, which allowed for Democratic support and final passage of the bill.

    When the House and Senate approved their respective bills originally, the votes were overwhelmingly bi-partisan. The Senate voted in favor of CARA by a vote of 94 to 1 on March 10 and the House vote on May 13 was 400 to 5. Some Republicans have argued that these bills did not have any more funding than the current version and that preliminary FY 2017 appropriations measures have included significant increases in funding to battle the opioid epidemic.

    As of this writing, the Senate is expected to begin considering the legislation as soon as Tuesday of next week.

    Hundreds of organizations, including ACEP and the ACEP-led Coalition to Stop Opioid Overdose, have endorsed CARA. On Friday, ACEP signed on to a Coalition letter expressing support for passage of the final bill as well as the need for it to be fully funded this year.

    Appropriations efforts are underway in the House next as the full House Appropriations Committee will be holding a markup next Wednesday (see below) on the draft Labor Health and Human Services Subcommittee bill that may include as much as $500 million in additional opioid funding.

    Please look for an Action Alert on Monday from ACEP asking you to send an email to your Senators asking them to vote yes on CARA and support additional funding this year.

    We will keep you apprised of continuing developments as they occur.

    Appropriations Update
    The House Labor-HHS-Education Appropriations Subcommittee approved its nearly $162 billion fiscal year 2017 spending bill by voice vote on Thursday despite objections from Democrats that it contains several “poison pill” policy riders, does not provide enough money for priorities like Zika, and cuts funding for CMS operations and family planning programs. The bill includes:
       • $73.2 billion for HHS ($2.6 billion increase over last year’s enacted level);
       • $33.3 billion for NIH ($1.25 billion increase);
       • $7.8 billion for CDC ($605 million increase), which would include $390 million to fight Zika, $300 million to establish a new Infectious Diseases Rapid Response Reserve Fund (for use in emergencies such as Ebola and Zika), $90 million to expand efforts to combat prescription drug abuse, and $1.5 billion for Public Health Preparedness and Response;
       • $4.2 billion for SAMHSA ($431 million increase);
       • $6.1 billion for HRSA ($218 million decrease), which includes $1.5 billion for Community Health Centers and $300 million for Children’s Hospital Graduate Medical Education; and
       • $3 billion for CMS management and operations ($576 million decrease).

    The committee defeated an amendment that would allow the CDC to conduct gun violence prevention research. However, ACEP was successful in its efforts to include report language similar to what was included in the Senate Labor-HHS-Education bill that would instruct CCIIO to publish additional information about how the agency establishes usual, customary and reasonable charges for insurance exchange out-of-network charges.

    The full House Appropriations Committee is scheduled to consider the bill on Thursday.

    ACEP Witness Set to Testify Before Congress
    On Tuesday, ACEP member and EMS Committee Chair Dr. Craig Manifold will testify before the House Energy and Commerce Health Subcommittee regarding H.R. 4365, the “Protecting Patient Access to Emergency Medications Act of 2016,” which would codify the use of standing orders by EMS medical directors. The House unexpectedly went into recess before he was originally scheduled to testify on July 12.

  • Action Alert: Mental Health Reform

    ACEP 911 Network ACTION ALERT
    July 1, 2016

    ACEP anticipates that the U.S. House of Representatives will consider mental health reform on Tuesday, July 5th. 

    To "Take Action," please follow the link and ask your legislator to vote for H.R. 2646, the "Helping Families in Mental Health Crisis Act of 2015." You will need your ACEP login credentials to access this page. 

    The letter is editable and we encourage you to add your perspective as to why mental health reform is critical to you and your patients. 

    Background: For years, mental health resources have been on the decline and services for psychiatric patients in the United States are simply inadequate. As a result of this diminishing support, psychiatric patients are more and more often turning to emergency departments for their acute care needs. Unfortunately, it takes three times as long to find an inpatient bed for a psychiatric patient rather than a medical patient after the decision to admit has been made. These psychiatric patients require more physician, nurse and hospital resources than other patients and, thus, diminish our ability to evaluate and treat other medical patients who are awaiting emergency care services.

    To learn more about the legislation and ACEP's position, please review the "Mental Health Reform" on ACEP Advocacy's Key Issues page. 

    If you are having trouble accessing the ACEP Advocacy website, please contact Gabrielle Szlenkier at (202) 728-0610 ext. 3020 or gszlenkier@acep.org.

  • Weekly Update, June 24, 2016

    The House has adjourned and will return to business on Tuesday, July 5th. The Senate will be in session the week of June 27th and is scheduled to address Puerto Rico's debt crisis and funding for the Zika virus.
      
    In this issue:
    • House Passes Zika Funding Package
    • ACEP to Testify at House Hearing – Postponed
    • Senate Gun Amendments Fail
    • Medicare Trustees Report
    • GOP Health Plan Alternative Released


    House Passes Zika Funding Package
    House Democrats led a more than 25-hour sit-in over gun control on the House floor this week, which ended early Thursday morning after Republican leaders moved to adjourn the House through the July 4 recess - without a vote on this issue. As a result, House hearings and legislation that had been planned for consideration this week are now delayed until further notice. Shortly before adjourning early Thursday morning, the House voted with no debate to approve a House-Senate conference report on Zika funding. The $1.1 billion legislative package includes $476 million to CDC for mosquito control, $230 million to NIH for vaccines, $165 million to the State Department and USAID to respond to outbreaks overseas and $86 million for emergency response research through the Biomedical Advanced Research and Development Authority. The package is offset by about $750 million from unspent Ebola and Obamacare funds, in addition to another $100 million from HHS's administrative fund. It now heads to the Senate for a vote, where it's expected to face resistance. Republicans, who lack a supermajority in the Senate, will not be able to pass the Zika bill without some support from Democrats. And if the chamber passes a new version that can garner some bipartisan support, it will then head back to the House, which is out until next month.

    ACEP to Testify at House Hearing – Postponed
    The House Energy and Commerce Health Subcommittee was scheduled to hold a hearing today entitled, “Strengthening our Nation’s Trauma System.” ACEP member and EMS Committee Chair, Dr. Craig Manifold, was set to testify regarding issues impacting the emergency management system and specifically speak to pending ACEP-supported legislation H.R. 4365, “Protecting Patient Access to Emergency Medications Act.” Due to the House adjourning earlier than expected, the Friday hearing was postponed. We will keep you informed on an alternative date for the hearing. Click here to read Dr. Manifold’s testimony.

    • The “Protecting Patient Access to Emergency Medications Act” (H.R. 4365/S. 2932) introduced by Reps. Hudson (R-NC), GK Butterfield (D-NC) and Senator Cassidy (R-LA), seeks to streamline the ability for EMS care providers to receive, move, store and administer controlled substances. Since ACEP’s Hill visits in May, the legislation has received significant bi-partisan support, bringing the overall total co-sponsorship in the House to 121 and four in the Senate. The most recent additions include: Reps. Joyce Beatty (D-OH), Jeff Duncan (R-SC), Patrick McHenry (R-NC) and Keith Rothfus (R-PA).

    Senate Gun Amendments Fail
    Senators were not able to garner enough bipartisan support, or the 60 votes required, to pass a series of gun control measures Monday, the latest in a long string of failed attempts at enacting tighter curbs on firearms in the United States. However, a compromise bill to block suspected terrorists from buying guns overcame a test vote Thursday in the Senate. Senators voted 46-52 against tabling the bipartisan proposal spearheaded by Sen. Susan Collins (R-Maine). (Tabling the proposal would have cast it aside.) A similar proposal offered by Senator Ron Johnson (R-WI) failed to advance. Further legislative action on curbing gun violence is anticipated next week when the Senate reconvenes. Recent polls suggest broad support for legislation to keep suspected terrorists from buying guns.

    Medicare Trustees Report
    The report, issued on Wednesday, found that Medicare spending hadn't risen quickly enough to trigger the Independent Payment Advisory Board, while predicting that the trust fund would be exhausted in 2028, two years sooner than previously projected.

    GOP Health Plan Alternative Released
    Top Republicans in the U.S. House of Representatives unveiled their blueprint to overhaul the nation's healthcare system on Wednesday. The 37-page proposal, part of larger effort by House Speaker Paul Ryan to offer a Republican agenda ahead of the Nov. 8 elections, is broadly outlined and aims to slow the growth of health spending and relax federal rules for health insurance while still keeping some of the ACA’s more popular provisions. The proposal can be read here.
  • Weekly Update, June 17, 2016

    Both Chambers will be in session next week.

    In this issue:
    • House Committee Advances Mental Health Bill
    • Increased Effort to Lift Ban on CDC Gun Violence Research
    • ACEP Response to Orlando Mass Shooting
    • Other Actions in Congress to Address Gun Violence
    • Additional Co-sponsors Added to ACEP Supported Bills
    • Progress on Opioid Legislation
    • ACEP Comments on the Inpatient Hospital PPS Draft Rule for FY 2017


    ACEP President Dr. Jay Kaplan discusses gun violence on Capitol Hill on Friday.

    House Committee Advances Mental Health Bill
    The House Energy and Commerce Committee favorably reported, 53-0, a modified version of the “Helping Families in Mental Health Crisis” bill, H.R. 2646, originally introduced by Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX). The ACEP-supported legislation has garnered 197 bipartisan cosponsors in this Congress.

    ACEP has long supported meaningful mental health reform and committee approval was a significant step forward as the nation desperately needs to not only establish policies and programs for individuals with serious mental illness, but also provide sufficient resources for the necessary services. ACEP will continue to work with Congress to enact this vital legislation as it advances to the House floor, although given the congressional schedule, that is not likely until the fall.

    Specifically the bill creates an Assistant Secretary for Mental Health and Substance Use Disorders and the National Mental Health Policy Lab, extends the Assisted Outpatient Treatment (AOT) grants, authorizes grant funding to create new Assertive Community Treatment teams (ACT), promotes telemedicine services, liability protections for volunteers at Community Health Centers and Community Behavioral Health Centers, expands the mental health workforce, clarifies HIPPA privacy rules for patients with mental illness and their caregivers, codifies the recently released IMD rule allowing for up to 15 days per month of inpatient psychiatric care for many Medicaid beneficiaries and expands efforts to implement mental health parity in health plans.

    The Senate also has a mental health bill, which was also modified from the original ACEP-supported bill introduced by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) during the Senate Health, Education, Labor and Pensions (HELP) Committee mark-up. That bill, S. 1945, has generally been narrower in scope and less controversial than the House bill. However, the most recent changes to the House bill have made it more in-line with the Senate version.

    Both bills still have significant obstacles to overcome due to congressional schedules, the continued debate on firearms and flack of new funding for key portions of the reform legislation.

    To view the committee mark-up, click here.

    Increased Effort to Lift Ban on CDC Gun Violence Research
    Delegates at the annual AMA meeting this week approved an ACEP-supported policy directing the organization to lobby lawmakers to overturn a congressional appropriations policy that for more than 20 years has prevented the Centers for Disease Control (CDC) from funding studies on firearm-related violence. ACEP and the AMA back scientific, objective research which should not be the subject of partisan disputes in Congress. Despite the AMA and ACEP's position, the policy rider was again included in the FY 2017 Labor-HHS-Education Appropriations Act that was approved by a Senate Appropriations subcommittee last week.

    ACEP Response and Other Actions in Congress to Address Gun Injuries and Violence
    Following Sunday's mass shooting in Orlando, ACEP President Jay Kaplan, MD, FACEP called for more data on injuries and improved emergency response measures to better treat victims of gun violence.

    In an exclusive interview Monday with Modern Healthcare, Dr. Kaplan said that as the incidence of mass shootings persists in the U.S., first responders must collaborate to develop processes that share and analyze data learned from treating victims of mass shootings.

    After Sen. Chris Murphy (D-CT) led a nearly 15-hour filibuster on the Senate floor on Wednesday and Thursday, Republicans and Democrats have agreed to vote on four competing gun-related amendments on Monday (as part of the debate on the FY 2017 Commerce-Justice-State Appropriations Act).

    One amendment, offered by Sen. Dianne Feinstein (D-CA), would bar suspected terrorists from buying guns and allow the Justice Department to arbitrate disputes when people mistakenly are placed on the terrorist watch list. Another similar amendment will be offered by Sen. John Cornyn (R-TX), but it contains additional protections for gun owners and also covers people who have been under terror investigations within the last five years. The third amendment, offered by Sens. Murphy, Cory Booker (D-NJ) and Chuck Schumer (D-NY), would establish universal background checks for individuals purchasing firearms. The final amendment, sponsored by Sens. Chuck Grassley (R-IA) and Ted Cruz (R-TX), would add mental health considerations to firearms background checks, as well as boost funding for the National Instant Criminal Background Check System. Several of these proposals have unsuccessfully been considered in the Senate previously.

    Sens. Jeff Flake (R-AZ), Susan Collins (R-ME) and Kelly Ayotte (R-NH) are working on a separate idea that would add new safeguards to prevent terrorists from buying weapons and are searching for Democratic co-sponsors. Any vote of this proposal would occur after the Monday votes because it is not yet finished.

    It's been nearly a decade since Congress made any significant changes to federal gun laws. In April 2007, Congress passed a law to strengthen the instant background check system after a gunman at Virginia Tech was able to purchase his weapons because his mental health history was not in the instant background check database. Thirty-two people died in the shooting.

    Additional Co-Sponsors for ACEP-Supported Bills
    In addition to the recent action by the House Energy and Commerce Committee to advance mental health reform, some of the other legislative issues discussed during the Capitol Hill Visits at this year’s Leadership & Advocacy Conference continue to garner Congressional support.

    • The "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) introduced by Rep. Charlie Dent (R-PA) and Senator Roy Blunt (R-MO), which addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who perform EMTALA-related services with temporary protections under the Federal Tort Claims Act, continues to garner congressional support. Since last reported, additional Members of Congress have been added bringing the total co-sponsorship in the House to 109 and nine in the Senate. The most recent additions include: Reps. Alex Mooney (R-WV) and Cedric Richmond (D-LA).

    • The “Protecting Patient Access to Emergency Medications Act” (H.R. 4365/S. 2932) introduced by Reps. Hudson (R-NC), GK Butterfield (D-NC) and Senator Cassidy (R-LA), which seeks to streamline the ability for EMS care providers to receive, move, store and administer controlled substances. Since ACEP’s Hill visits in May, the legislation has received significant bi-partisan support, bringing the overall total co-sponsorship in the House to 117 and four in the Senate. The most recent additions include: Reps. Mike Bishop (R-MI), Kathy Castor (D-FL), Paul Gosar (R-AZ) and Gwen Graham (D-FL).

    Progress on Legislation to Address the Opioid Epidemic
    The Senate voted 66 to 29 on Thursday to go to conference with the House to sort out the differences between their respective bills that address the opioid epidemic.

    The Senate approved their CARA legislation on March 10 and the House approved several smaller pieces of legislation - many, but not all of which overlap with the Senate.

    Thursday's vote allows the conference meetings to formally begin.

    ACEP Comments on the Inpatient Hospital PPS Draft Rule for FY 2017
    • CMS incorporates a Congressionally-mandated revised notice to beneficiaries to let them know when they are considered “observation”/outpatient status in spite of being in an inpatient bed for 2-3 days. The notice is a modest improvement but doesn’t fix the underlying policy problem.

    • We continue to encourage CMS to require ED throughput measures which hospitals must report via chart and electronically.

    • CMS does not propose expanding diagnoses for the re-admission penalty program, although the CABG measure approved last year will be implemented in FY 2017.

  • Weekly Update, June 10, 2016

    The House and Senate will be in session the week of June 13.

    Senate Judiciary Hearing on Synthetic Drugs
    Senate Advances Labor-HHS Appropriations
    House to Mark-up Mental Health Bills
    House Energy & Commerce Activity
    Hospital Bill Passes in the House
    Rural Broadband Bill to become Law
    Additional Co-sponsors Added


    Senate Judiciary Hearing on Synthetic Drugs
    This week, ACEP member, Dr. Sullivan Smith, testified before the Senate Judiciary Committee on the growing illicit synthetic (chemically enhanced) drug problem in the United States. ACEP supports H.R 3537 “Synthetic Drug Control Act,” which was introduced last fall by Rep. Charlie Dent (R-PA). If enacted, the law will add more than 200 known synthetic drugs to Schedule I of the Controlled Substances Act and facilitate federal prosecution of the manufacturers, distributors and sellers of synthetic drugs.

    To view ACEP’s press release, click here.

    To view the entire hearing or read a transcript, click here.


    Dr. Sullivan Smith of Cookeville Regional Medical Center in Cookeville, TN testifying before the Senate Judiciary Committee on Tuesday.

    Senate Advances Labor-HHS Funding Bill
    The Senate Appropriations Committee has approved the first bipartisan Labor-HHS funding bill since the ACA became law more than six years ago. The bill advanced quickly this week through both the Senate subcommittee and full committee. ACEP was successful in adding report language to the bill that instructs the Center for Consumer Information and Insurance Oversight (CCIIO) to publish additional information about how the agency is establishing usual, customary and reasonable charges for insurance exchange out-of-network charges that determine emergency physician reimbursement in those circumstances. Report language was also included that encourages the HHS Assistant Secretary for Preparedness and Response (ASPR) to develop a proposal for how trauma centers and systems can be improved to ensure adequate availability and response during mass casualty events.

    In addition, the legislation would provide $161.9 billion in base discretionary funding for the departments of Labor, Health and Human Services, Education and related agencies in FY 2017, $270 million less than FY 2016. HHS programs would receive $76.9 billion, $1.4 billion more than in FY 2016, according to a committee summary. This includes a $2 billion increase for the National Institutes of Health; $126 million increase for programs to combat opioid abuse; $80 million increase for mental health programs; $5 million increase for Children’s Hospitals Graduate Medical Education; $5 million increase for the Office of Medicare Hearings and Appeals; and $3 million increase for rural health programs. The legislation also includes $1.96 billion to prevent waste, fraud, abuse and improper payments in the Social Security, Medicare and Medicaid programs; eliminates funding for the Independent Payment Advisory Board; and would prevent using funds for Risk Corridor payments. The Agency for Healthcare Research and Quality will receive $324 million in funding next year, a cut of $10 million from its current level. The House Labor HHS Appropriations subcommittee is expected to take up its bill later this month.
      
    House Committee to Mark-up Mental Health Legislation
    On June 15, the House Energy and Commerce Committee will mark-up several bills including the ACEP-supported legislation, H.R. 2546, the “Helping Families in Mental Health Crisis Act” sponsored by Rep. Tim Murphy (R-PA). The committee plans to offer a manager's amendment (a package of individual amendments agreed to by both parties in advance) to the bill at markup that addresses some earlier concerns by Democrats and some Republicans about patient privacy and cost. The bill provides funding for existing grant programs to support assisted outpatient treatment programs, funds prevention and intervention programs, and restructures the SAMHSA leadership. The original bill without the manager’s amendment was approved by the Energy and Commerce Health subcommittee, mostly along party lines, last November.

    Other Energy & Commerce Committee Activity
    The House Energy and Commerce Committee advanced two bills out of committee this week.

    H.R. 921 – The “Sports Medicine Licensure Act,” (Rep. Guthrie R-KY) this legislation would ensure that sports medicine professionals are properly covered by their malpractice insurance while traveling with athletic teams to another state.

    H.R. 3299 – The “Strengthening Public Health Emergency Response Act” (Reps. Brooks R-IN and Eshoo D-CA) would increase American emergency preparedness by increasing administrative efficiency within the Office of Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services and provide incentives for companies to spur development of medical countermeasures for public health emergencies and biochemical attacks.

    Rural Broadband Bill to Become Law
    The “Rural Health Care Connectivity Act” (S.1916), introduced by Senator John Thune (R-SD), was included in the final conference version of the toxic chemical safety bill that passed the Senate by Unanimous Consent on Tuesday evening. The House passed the bill earlier this year and it now goes to the President’s desk to be signed into law. The bill expands rural broadband to make it easier for rural hospitals to adopt telemedicine and EHRs.

    Hospital Bill Passes the House
    On Tuesday, the House passed the “Helping Hospitals Improve Patient Care Act” (H.R. 5273). The bill was recently introduced by Reps. Pat Tiberi (R-OH) and Jim McDermott (D-WA) and advanced through the House Ways and Means Committee before the Memorial recess. The bill is favored by the American Hospital Association and other industry groups, and is intended to protect hospitals with outpatient centers disproportionately hit with fees from the Medicare rule which became law as part of last year’s omnibus spending bill. The bill would also add beds for long-term care hospitals, extend a rural hospital demonstration program and delay the administration’s authority to terminate certain Medicare Advantage contracts. It remains unclear if or when the legislation will be considered in the Senate.

    Additional Co-sponsors for ACEP-Supported Bills
    Some of the key legislative issues discussed during the Capitol Hill Visits at this year’s Leadership & Advocacy Conference continue to garner Congressional support.

    • The "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) introduced by Rep. Charlie Dent (R-PA) and Senator Roy Blunt (R-MO), which addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who perform EMTALA-related services with temporary protections under the Federal Tort Claims Act, continues to garner congressional support. Since last reported, additional Members of Congress have been added bringing the total co-sponsorship in the House to 107 and nine in the Senate. The most recent additions include:

    o Senator John Boozman (R-AR)
    o Representatives Tom Graves (R-GA), Kenny Marchant (R-TX), Scott Tipton (R-CO) and David Trott (R-MI)

    • The “Protecting Patient Access to Emergency Medications Act” (H.R. 4365/S. 2932) introduced by Reps. Hudson (R-NC), GK Butterfield (D-NC) and Senator Cassidy (R-LA), which seeks to streamline the ability for EMS care providers to receive, move, store and administer controlled substances. Since ACEP’s Hill visits in May, the legislation has received significant bi-partisan support, bringing the overall total co-sponsorship in the House to 113 and four in the Senate. The most recent additions include:

    o Senator Jeff Merkley (D-OR)
    o Representatives Brian Babin (R-TX), Keith Ellison (D-MN), Kay Granger (R-TX), Jaime Herrera Beutler (R-WA),Erik Paulsen (R-MN), Robert Pittenger (R-NC), Jim Renacci (R-OH), Hal Rogers (R-KY), Jason Smith (R-MO), Steve Stivers (R-OH) and Cedric Richmond (D-LA).

  • Weekly Update, May 26, 2016

    Both the Senate and House have adjourned for a week-long Memorial Day recess and will return to business on Tuesday, June 7. 

    In this issue:
    • Mental Health Summit with Dr. Peter Jacoby
    • Upcoming Congressional Hearing with Dr. Sullivan Smith
    • Zika Funding Update
    • Hospital Bill Advances in House
    • Additional Cosponsors Added to ACEP-supported bills

    ACEP Participates in Bipartisan Mental Health Summit
    On Thursday, ACEP member Dr. Peter Jacoby participated in the Senate Summit on Mental Health, which was sponsored by two of the co-authors of the "Mental Health Reform Act," Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT). The summit featured mental health experts, healthcare providers and patient advocates. Dr. Jacoby was on a panel with Sheriff Greg Champagne and advocate Hakeem Rahim. Their panel discussed the unique challenges they face in their respective roles in seeking or providing mental health services and how those obstacles could become even more difficult if Congress fails to enact mental health reform this year.

          
    To view a video of the summit,
    click here.

    ACEP Witness to Testify at Senate Hearing on Synthetic Drugs
    On Tuesday, June 7, ACEP member Dr. Sullivan Smith is scheduled to testify before the Senate Judiciary Committee at a hearing entitled: "Deadly Synthetic Drugs: The Need to Stay Ahead of the Poison Peddlers." Dr. Smith will describe what it's like to treat patients who are using illicit synthetic drugs; discuss how these drugs impact individuals, families and communities; as well as evaluate various legislative proposals being considered by Congress to address this problem.

    Zika Funding Fight Continues
    Despite urgent warnings from federal health officials about the dangers of a Zika virus outbreak in the U.S., Congress is still struggling to reach an agreement to provide emergency funding to battle the mosquito-borne virus. Last week, the Senate approved a bill to provide $1.1 billion for mosquito-extermination efforts, testing and vaccine research. The House-passed version only provides $622 million and redirects money from other programs to pay for it, such as from previously dedicated Ebola funds. Congressional Republicans have suggested they want to appoint a committee to reconcile the two bills, but Democrats argue they've already compromised and agreed to considerably less than the White House's initial request in February for $1.9 billion.

    Hospital Bill Advances in House Committee
    At a Congressional mark-up earlier this week, the House Ways and Means Committee approved by voice vote the “Helping Hospitals Improve Patient Care Act” (H.R.5273). The bill was introduced last week by Health Subcommittee Chairman Pat Tiberi (R-OH) and Ranking Member Jim McDermott (D-WA). One provision of the bill would revise Section 603 of the 2015 Bipartisan Budget Act to move the grandfather date for off-campus hospital outpatient departments (HOPD) from Nov. 2, 2015 to Dec. 31, 2016 or 60 days after enactment, whichever is later.  The Bipartisan Budget Act grandfathered existing facilities at the HOPD rate, while newer facilities are capped at the lower Physician Fee Schedule rate.  The bill would also adjust the Hospital Readmissions Reduction Program to account for socioeconomic status, and extend the Rural Community Hospital Demonstration Program for five years. While the legislation is supported by many in the House, it is unclear at this time what the Senate plans are to address the issue. 

    2016 LAC Wrap-Up – Hill Visits Garner Additional Co-sponsors for ACEP-Supported Bills
    Some of the key legislative issues discussed during the Capitol Hill Visits at this year’s Leadership & Advocacy Conference have garnered additional support in Congress. Thank you to those of you who took the time to attend LAC16 and meet with your Congressional representatives and their staff. Your continued outreach and follow-up strengthens ACEP advocacy efforts.  

    • The "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) introduced by Rep. Charlie Dent (R-PA) and Senator Roy Blunt (R-MO), which addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who perform EMTALA-related services with temporary protections under the Federal Tort Claims Act, continues to garner congressional support. Since last reported, additional Members of Congress have been added to the House bill bringing the overall total co-sponsorship in the House to 103 and 8 in the Senate. The most recent additions include:                 
      • Senator Lisa Murkowski (R-AK)   
      • Reps. Dan Donovan (R-NY), Jeb Hensarling (R-TX), Mike McCaul (R-TX), Robert Pittenger (R-NC) and Scott Rigell (R-VA)   
    • The “Protecting Patient Access to Emergency Medications Act” (H.R. 4365/S. 2932) introduced by Reps. Hudson (R-NC), GK Butterfield (D-NC) and Senator Cassidy (R-LA), which seeks to streamline the ability for EMS care providers to receive, move, store and administer controlled substances.  Since our Hill visits last week the legislation has received significant bi-partisan support, bringing the overall total co-sponsorship in the House to 101 and three in the Senate.  The most recent additions include:
      • Senators Kelly Ayotte (R-NH), Mark Kirk (R-IL) and Jon Tester (D-MT)
      • Reps. Andy Barr (R-KY), Don Beyer (D-VA), Mo Brooks (R-AR), Julia Brownley (D-CA), Larry Bucshon (R-IN), John Carter (R-TX), John Conyers (D-MI), Elijah Cummings (D-MD), Suzan DelBene (D-OR), Robert Dold (R-IL), Daniel Donovan (R-NY), Randy Forbes (R-VA), Tom Graves (R-GA), Frank Guinta (R-NH), Derek Kilmer (D-WA), David Joyce (R-OH), Leonard Lance (R-NJ), Ted Lieu (D-CA), Mike McCaul (R-TX), Cathy McMorris Rodgers (R-WA), Kenny Marchant (R-TX), Scott Rigell (R-VA), Peter Roskam (R-IL), Janice Schakowsky (D-IL), Chris Van Hollen (D-MD), Ann Wagner (R-MO), Tim Walberg (R-MI), Jackie Walorski (R-IN), and Peter Welch (D-VT).

    To learn more about legislative issues impacting emergency medicine, go to the ACEP Advocacy website.  

    We continue to update ACEP Advocacy Website with photos from the Hill visits during LAC as well as the NEMPAC Website with photos from contributor recognition activities at the meeting and recent activities related to NEMPAC-supported candidates.

  • Weekly Update, LAC16 Special Edition

    ACEP 911 Network Weekly Update: 
    2016 Leadership & Advocacy Conference Edition - May 20, 2016

    Both chambers will be in session next week. 

    In this issue:
    • 2016 ACEP Leadership & Advocacy Conference 
    • 911 Network Member of the Year
    • Coalition to Stop Opioid Abuse 
    • NEMPAC Activities during LAC


    ACEP’s 2016 “Leadership & Advocacy Conference” brings hundreds of Emergency Physicians to Washington, DC and Capitol Hill
    A record number of nearly 600 emergency physicians visited with federal legislators and staff on Capitol Hill during the ACEP 2016 Leadership and Advocacy Conference in Washington, DC this week. Conference attendees (including residents and many first-timers) from 47 states, the District of Columbia and Puerto Rico participated in 405 meetings in Capitol Hill offices with legislators and/or their health care staff.  94% of Senate offices were visited and 71% of the House of Representatives’ offices were visited.  Check-out the activities LAC attendees participated in throughout the week by searching the official #LAC16 hashtag on Facebook and Twitter!

    ACEP President Dr. Jay Kaplan introduced LAC attendees to a brand-new advocacy platform powered by Phone2Action that alerted legislators that ACEP members were coming to Capitol Hill. In just a few minutes time, simply by using their smartphones, LAC attendees sent more than 1,200 communications to legislators instantly via email, Twitter, and Facebook. Watch Dr. Kaplan cheer on LAC attendees as their messages were sent live to legislators from all over the nation.

    The conference touched on several important topics such as ACEP’s Registry (CEDR), recently released regulations shaping the new physician payment system, strategies to deal with out of network billing issues and the importance of physician involvement in the political process. Participants heard real time political analysis from featured speaker Charlie Cook, panel presentations from physician leaders from the American Medical Association (AMA) and American Hospital Association (AHA) and took a deep dive on the legislative issues currently impacting emergency medicine in the 114th Congress. While on Capitol Hill, ACEP members:

    • Asked legislators to re-engage legislative efforts to expand access to psychiatric services and provide appropriate mental health resources for constituents and patients with mental illness.
    • Informed legislators and staff on emergency medicine principles for opioid prescribing.
    • Asked legislators to “co-sponsor” bipartisan legislation to protect the current practice of using written “standing orders” by physician medical directors overseeing care provided in the field by paramedics and other EMS practitioners. The ACEP-supported bills H.R. 4365/S.2932 are sponsored by Representative Richard Hudson (R-NC) and Sen. Bill Cassidy (R-LA) respectively.
    • Thanked the 100 plus Representatives and Senators who have already co-sponsored the “Health Care Safety Net Enhancement Act of 2015” (H.R.836/S.884), sponsored by Representative Charlie Dent (R-PA) and Senator Roy Blunt (R-MO). The bi-partisan legislation provides medical liability relief for physicians providing care under the EMTALA mandate.  Participants also asked legislators to co-sponsor the bills and advocate for further action through Congress. 
    • Invited Members of Congress and their staff to visit a local Emergency Department and learn first-hand the healthcare issues impacting their constituents and communities. 

    The Lobby Day issue papers are available on the ACEP Advocacy website with your login credentials.


    911 Network Member of the Year 

    Dr. Jasmeet Dhaliwal, EMRA Legislative Committee Chair and Board member and Chief Resident at Denver Health/University of Colorado, was awarded the 911 Network Member of the Year Award by ACEP President Dr. Jay Kaplan. Dr. Dhaliwal was recognized for his outstanding efforts in encouraging a record number of residents across the country to get involved in the federal advocacy process over the past year.

    Coalition to Stop Opioid Abuse 
    On Thursday, Dr. Kaplan helped launch the newly formed Coalition to Stop Opioid Overdose. The group, which is comprised of physician organizations, patient advocacy groups, addiction treatment specialists and other interested parties, advocates for improved access to medication-assisted treatment (MAT), expanded availability of naloxone, enhanced prescription drug monitoring programs (PDMPs), increased opioid prescriber education, and enactment of comprehensive opioid reform legislation. To learn more about the coalition,click here.

    During the press conference, Dr. Kaplan was joined by Rep. Tim Ryan (D-OH), Sens. Joe Manchin (D-WV), Rand Paul (R-KY) and Amy Klobuchar (D-MN), SAMHSA Principal Deputy Administrator Kana Enomoto, and other members of the coalition steering committee. To see a video recap of the press conference, click here.

    Unable to attend the LAC16 Conference this year? 
    You can participate in our “Virtual Lobby Day” by visiting the ACEP Grassroots Advocacy Website and clicking “Take Action.” 

    Mark your calendars for next year's Leadership and Advocacy Conference, March 12-15, 2017 in Washington DC

    NEMPAC's Activities and Impact during LAC 
    Dr. Jay Kaplan and NEMPAC Chairman Dr. Peter Jacoby hosted the NEMPAC VIP Reception on the rooftop of the Hay Adams Hotel.  To view highlights of NEMPAC's most generous donors and one of the best views in Washington, DC, please visit the NEMPAC Media Gallery where images are added daily. 

    A record-breaking $120,000 was raised in conjunction with the LAC meeting toward NEMPAC’s $2 million goal for the election cycle. Special recognition was given to: CEP America, Eastside Emergency Physicians, EmCare, Florida Emergency Physicians (FEP), TeamHealth, USACS, and WEPPA for group fundraising campaigns in conjunction with the meeting.

    NEMPAC hosted nine fundraising “Dine-Arounds” for Members of Congress and ACEP members attended four additional fundraising events during the LAC16 meeting. More than 100 ACEP leaders, NEMPAC Board members, and conference attendees participated in the dinners adding their personal donations to NEMPAC contributions for the following legislators’ election campaigns:

    • Rep. Michael Burgess (R-TX) 
    • Senator Richard Blumenthal (D-CT) 
    • Rep. Richard Hudson (R-NC)
    • Rep. David Joyce (R-OH)
    • Rep. Jim Langevin (D-RI)
    • Rep. Cathy McMorris Rodgers (R-WA)
    • Dr. Mark Plaster (MD-03 candidate), emergency physician
    • Rep. Peter Roskam (R-IL)
    • Rep. Raul Ruiz (D-CA), emergency physician


    Due to last minute House votes, a fundraiser for Rep. Joe Heck for Senate (R-NV) was cancelled. Efforts are underway to reschedule during ACEP16 in Las Vegas. 

    Rep. David Jolly (R-FL) and Rep. Jared Polis (D-CO) hosted ACEP members for evening tours of the Capitol as well.

  • Weekly Update, April 29, 2016

    Both chambers will be in recess next week.

    In this issue:
    • House Committees Advance Opioid Legislation
    • Senate Finance Cmt Hearing on Mental Health Reform
    • CMS Releases MACRA Rule
    • Medicaid Managed Care Rule
    • Two Midnight Rule Update
    • Update on ACEP Leadership and Advocacy Conference, May 15-18

    House Committees Advance Opioid Bills

    As part of a multi-day markup this week, the House Energy and Commerce Committee advanced several bills related to prescription drug abuse, which they hope will help to curtail the national epidemic. The slate of measures touched on a variety of issues including co-prescribing at-risk patients, substance abuse treatment programs for pregnant women, and naloxone education, among other things. The bills are expected to be packaged with legislation approved, in the House Judiciary and Education & Workforce committees this week. While proposed funding for the House bills is less clear, the largely bipartisan bills are expected to receive a full floor vote in the House the week of May 9. The bills could then be reconciled later this year with the broader Senate-passed Comprehensive Addiction and Recovery Act (S. 524), which includes $80 million proposed funding for drug abuse treatment and prevention programs.

    ACEP has created a list of pain management/opioid principles that we have shared with Members of Congress as they consider legislative solutions to the opioid epidemic. The principles stress balancing the legitimate needs of patients in pain with efforts to reduce unwarranted use of prescription medications. To view ACEP's Emergency Medicine Opioid Principles, click here.

    Emergency physicians’ role in providing solutions to the substance abuse epidemic will be one of the key issues addressed during ACEP’s Lobby Day on May 17 when more than 500 ACEP members will visit their legislators’ offices on Capitol Hill.


    Senate Finance Committee Examines Mental Health Issues
    The Senate Finance Committee convened a hearing yesterday titled, “Mental Health in America‎: Where Are We Now?” to examine various options on how to address mental health issues in our health care system. To view yesterday’s hearing, click here.

    As reported in previous Weekly Updates, the Senate Health, Education, Labor and Pensions Committee (HELP) unanimously voted to move a mental health reform bill out of committee last month, but several members called for removing an old Medicaid policy that restricts federal funding for clinics with more than 16 beds treating mental health and substance abuse patients. Undoing this policy would cost between $40 and $80 billion, depending on how the legislation is written, and falls under the jurisdiction of the Finance Committee.

    We anticipate that the Senate leadership will combine legislation from the three committees with jurisdiction over this issue into a larger package which could reach the Senate floor sometime this summer. However lack of coordination among the committees, the overall cost of the legislation, as well as contentious proposals on firearms continue to impede the progress of overall mental health reform in the already condensed Senate calendar.

    Mental health reform will be one of the key issues discussed during ACEP’s Lobby Day on May 17 when more than 500 ACEP members will visit their legislators’ offices on Capitol Hill.

    CMS Releases MACRA Rule
    On Wednesday, CMS released the 963-page rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA legislation repealed the SGR formula for Medicare physician reimbursements, ending more than a decade of last-minute fixes and potential payment cliffs.

    Currently, Medicare measures the value and quality that physicians and other clinicians provide through a patchwork of programs. The MACRA legislation streamlined these programs into a single framework to help transition to payments based on value from payments based on volume. The proposed rule would implement changes through a unified framework known as the Quality Payment Program, which includes two paths; the Merit-based Incentive Payment System or the Alternative Payment Model and proposed quality measures for each. CMS will be accepting comments on the proposed rule over the next 60 days.

    ACEP has established an Alternative Payment Model (APM) Task Force to help develop arrangements that will allow emergency physicians to participate in these new payment systems, although the practice of emergency medicine does not easily fit into any of the proposed models. We are also preparing to respond to this first iteration of CMS regulations on these programs.

    For more information on the MACRA proposed rule, review the press release and visit the webpage.

    Medicaid Managed Care Regulation
    A long-awaited revision to Medicaid Managed Care regulations contained a win for psychiatric patients and ACEP members. Doctors will be able to admit Medicaid MCO enrollees ages 21 to 64 to private psychiatric hospitals, which should help reduce ED boarding as 70 % of Medicaid population is currently enrolled in managed care plans. The previous restriction has been in place since the beginning of the program when states operated their own psychiatric hospitals. ACEP strongly supported this long overdue change in our comments.

    Two-Midnight Rule
    In the Medicare Inpatient Draft Rule for FY 2017, CMS proposes returning funds withheld from hospitals under the 2-midnight rule. CMS based the withholding on estimates of increased inpatient admissions under the 2-midnight policy (rather than multi-day “observation” stays on inpatient units.)

    Registration Deadline Nearing for 2016 Leadership and Advocacy Conference
    Limited Hotel Rooms Available
    May 15-18, 2016 in Washington, D.C.

    Don’t miss the opportunity to take your advocacy to the next level in this critical election year!

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    Already more than 200 legislator meetings have been scheduled for attendees on Tuesday, May 17 for ACEP’s Lobby Day, many with House and Senate leaders and members of key healthcare committees. Before heading to Capitol Hill for ACEP’s Lobby Day, attendees will hear from ACEP members Rep. Joe Heck (R-NV) and Rep. Raul Ruiz (D-CA), who will share their experiences as emergency physician/members of Congress, provide insight into the health care agenda of Congress, and discuss the importance of physician involvement in policymaking and the political process.

    To read more about Dr. Heck’s campaign for the U.S. Senate and Rep. Ruiz’ re-election campaign to the U.S. House, please click on the following links:
    https://www.heck4nevada.us/
    http://www.drraulruiz.com/

    Wednesday, May 18 will be devoted to the leadership courses where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    Congressional Dine-Arounds during LAC
    NEMPAC will again be hosting Congressional Dine-Arounds for key members of Congress during the LAC. Join your emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC. Most of the dinners will begin at 6:30 or 7:00 pm and will be at restaurants near the Grand Hyatt Hotel or Capitol Hill.

    The schedule is as follows:

    Monday evening, May 16
    Rep. Richard Hudson (R-NC)
    Senator Richard Blumenthal (D-CT)
    Rep. Peter Roskam (R-IL)
    Rep. David Joyce (R-OH),

    Tuesday evening, May 17
    Rep. Michael Burgess (R-TX)
    Rep. Jim Langevin (D-RI)
    Rep. Cathy McMorris Rodgers (R-WA)
    Rep. Joe Heck for NV Senate (dessert reception)
    Rep. Raul Ruiz (D-CA)
    Dr. Mark Plaster, candidate for congress in Maryland’s 3rd congressional district

    To RSVP or for additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

  • Weekly Update, April 22, 2016

    The House and Senate will be in session next week.

    In this issue:
    • House Advances Opioid Legislation
    • EMTALA Liability Legislation
    • Senate Schedules Hearing on Mental Health Reform
    • House Committee Looks at MACRA Implementation
    • CMS Reverses Two-Midnight Payment Reductions
    • CMS Announces New Payment Rules
    • Update on ACEP Leadership and Advocacy Conference, May 15-18

    House Committee Advances Opioid Legislation
    On Wednesday, the House Energy and Commerce Health Subcommittee approved a dozen bills related to prescription drug abuse they hope will help curtail this national epidemic. The legislative proposals touched on a variety of issues, including neonatal abstinence syndrome, medication-assisted treatment, dextromethorphan and naloxone, among other things. Only a few of the bills were amended and all were approved by voice vote. The full Energy and Commerce Committee is expected to consider these bills next week. The House leadership also expects to see opioid proposals advance in the Education and Workforce, Ways and Means, and Judiciary Committees before the final product is ready for floor consideration, which should occur in May.

    In addition to the sponsors of these individual measures, the bills are being promoted by the bipartisan congressional opioid task force, which now has nearly 80 members. The task force is calling for no new funding but would pay for the measures - totaling about $800 million - with cuts to other domestic, discretionary spending accounts.

    The Senate approved its opioid legislation, the "Comprehensive Addiction and Recovery Act (CARA)" (S. 524), on March 10 by a vote of 94 to 1.

    As noted in last week’s edition of the Weekly Update, ACEP's Federal Government Affairs Committee Chairman Tony Cirillo, MD, FACEP, participated in a congressional briefing on prescription drug misuse/abuse last week, which focused on opioids, heroin and other illicit drugs. Dr. Cirillo was asked to discuss several legislative proposals with members of the congressional Doctors Caucus and Prosecutors Work Group, including bills related to naloxone availability and liability protections associated with its use, synthetic drugs and how the DEA undertakes enforcement actions against providers who may have inadvertently violated the Controlled Substances Act.

    ACEP has created a list of pain management/opioid principles that we have shared with Members of Congress as they consider legislative solutions to this dangerous epidemic. The principles stress balancing the legitimate needs of patients in pain with efforts to reduce unwarranted use of prescription medications. To view ACEP's Emergency Medicine Opioid Principles, click here.

    EMTALA Liability Bill Garners More Support in the House
    One of ACEP's top legislative priorities, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) continues to garner congressional support. Since last reported, additional Members of Congress have been added to the House bill bringing the overall total co-sponsorship in the House to 98 and six in the Senate. The most recent additions include Rep. Ryan Costello (R-PA) and Stephen Knight (R-CA).

    Specifically, the legislation addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who perform EMTALA-related services with temporary protections under the Federal Tort Claims Act. The legislation will be one of the key issues discussed during ACEP’s Lobby Day on May 17 when more than 500 ACEP members will visit their legislators’ offices on Capitol Hill.

    Senate Finance Committee Schedules Hearing on Mental Health
    On Thursday, April 28th the Senate Finance Committee will hold a hearing on "Mental Health in America: Where Are We Now?"

    As reported earlier by the Weekly Update, mental health has been highlighted as one of the main issues that could gain legislative traction this year and is one of ACEP’s top legislative priorities.

    The Senate Health, Education, Labor and Pensions Committee (HELP) unanimously voted to move a mental health reform bill out of committee last month, but several members called for removing an old Medicaid policy that restricts federal funds for clinics with more than 16 beds treating mental health and substance abuse patients. Undoing that rule would cost between $40 and $80 billion, depending on how legislation is written, and falls under the jurisdiction of the Finance Committee.

    Mental health reform will be one of the key issues discussed during ACEP’s Lobby Day on May 17 when more than 500 ACEP members will visit their legislators’ offices on Capitol Hill.

    House E&C Committee Hearing Examines Progress of MACRA Implementation
    On Tuesday the House Energy and Commerce Committee held the second in a series of hearings on implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), focusing on physician efforts to prepare for the Medicare payment reforms. To learn more about the MACRA law and next steps for implementation, click here for a Health Affairs brief on the law. ACEP has established an Alternative Payment Model (APM) Task Force to help develop arrangements that will allow emergency physicians to participate in these new payment systems, although the practice of emergency medicine does not easily fit into any of the proposed models. We are also preparing to respond to the first iteration of CMS regulations on these programs, which is expected to be released within the next week or two.

    CMS Reverses Two-Midnight Payment Reductions to Hospital Inpatient Rates
    The FY 2017 draft rule for inpatient hospitals (IPPS) proposes to rescind the 0.2% reduction CMS imposed on the hospital standardized rate since 2014. Reductions accounted for an estimated increase in Program costs due to the 2-midnight stay policy, which was projected to result in a higher rate of inpatient admissions. The American Hospital Association contested the reductions in court and CMS is repaying those amounts with 1.006 % added back to DRG rates for FY2017. No other changes to the 2-midnight policy are included for next year.

    CMS Announces New Payment Rules
    CMS on Thursday released proposed Medicare fiscal 2017 payment rules for hospice, nursing homes, and inpatient rehab facilities in spite of recommendations from MedPAC to eliminate market basket updates for all three and move forward to develop a unified post-acute payment system.

    • Hospice: 2.0 percent payment increase. The agency is also proposing two new hospice quality measures for 2017. One will assess staff visits during the last week of life, while the other will look at whether patients received treatment consistent with federal guidelines in areas such as pain assessment.
    • Skilled Nursing homes: 2.1 percent payment increase. To comply with the IMPACT Act, CMS proposed one new assessment-based quality measure and three claims-based measures to be included in the nursing homes' quality reporting program.
    • Inpatient rehab: 1.6 percent payment increase.

    Registration Deadline Nearing for 2016 Leadership and Advocacy Conference
    Limited Hotel Rooms Available
    May 15-18, 2016 in Washington, D.C.

    Don’t miss the opportunity to take your advocacy to the next level in this critical election year!

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    Already 126 legislator meetings have been scheduled for attendees on Tuesday, May 17 for ACEP’s Lobby Days, many with House and Senate leaders and members of key healthcare committees. Before heading to Capitol Hill for ACEP’s Lobby Day, attendees will hear from ACEP members Rep. Joe Heck (R-NV) and Rep. Raul Ruiz (D-CA), who will share their experiences as emergency physician/members of congress, provide insight into the health care agenda of Congress, and discuss the importance of physician involvement in policymaking and the political process.

    To read more about Dr. Heck’s campaign for the U.S. Senate and Rep. Ruiz’ re-election campaign to the U.S. House, please click on the following links:
    • https://www.heck4nevada.us/ 
    • http://www.drraulruiz.com/

    Wednesday, May 18 will be devoted to the Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    Congressional Dine-Arounds during LAC
    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress during the LAC. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI), Rep. Peter Roskam (R-IL), Rep. Cathy McMorris Rodgers (R-WA), Rep. David Joyce (R-OH), Rep. Joe Heck for NV Senate and ACEP member Dr. Mark Plaster, candidate for congress in Maryland’s third congressional district.

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

  • Weekly Update, April 15, 2016

    The House and Senate will be in session next week.

    In this issue:
    -House readying for action on opioid crisis
    -Senate advances appropriations process
    -Upcoming hearings
    -Update on ACEP Leadership and Advocacy Conference, May 15-18

    House Preparing to Take Action on Opioids

    ACEP participated in congressional briefing this week

    On Wednesday, ACEP's Federal Government Affairs Committee Chairman Tony Cirillo, MD, FACEP, participated in a congressional briefing on prescription drug misuse/abuse, which focused on opioids, heroin and other illicit drugs. Dr. Cirillo was asked to discuss several legislative proposals with members of the congressional Doctors Caucus and Prosecutors Work Group, including bills related to naloxone availability and liability protections associated with its use, synthetic drugs and how the DEA undertakes enforcement actions against providers who may have inadvertently violated the Controlled Substances Act.

    In addition to briefing Members of Congress on these legislative issues, Dr. Cirillo highlighted the human suffering associated with drug abuse and overdose and how emergency physicians must constantly balance the pain management needs versus desires of their patients. He discussed the factors that led to this epidemic and emphasized ACEP's desire to partner with lawmakers to develop meaningful legislative solutions. Representatives from the AMA, OB-GYNs and addiction medicine were also on the panel.

    The House leadership has stated it does not intend to take-up the opioid legislation approved by the Senate a couple of weeks ago. Instead they are opting to give members an opportunity to advance their individual drug abuse and treatment proposals. House Majority Leader Kevin McCarthy (R-CA) stated last week that the relevant committees should approve the various bills this month so that they may be combined into one package that the full House could vote on in May. We expect the House Energy and Commerce Health Subcommittee to begin the process next week.

    Once the House approves a final bill, it would need to be reconciled with the Senate proposal before the final legislation could be sent to the president. However, finding the appropriate funding remains the single biggest obstacle to implementing meaningful reforms.

    Senate Continues Appropriations Process
    On Thursday afternoon the Senate advanced efforts to fund the federal government when the Senate Appropriations Committee approved subcommittee spending allocations for fiscal 2017 by a vote of 29-1 vote. Sen Jerry Moran (R-KS) voted against the proposal. This bipartisan effort is the latest sign that the Senate will actually try to pass appropriations bills this year. While some appropriations bills saw relatively big increases - the largest of the non-defense bills, Labor-HHS-Education, was cut just 0.1 percent from $162.1 billion down to $161.9 billion. The Senate, like the House, has not passed a budget that typically sets total spending. Republicans have argued a budget is less important this year because last year's bipartisan budget law set a total discretionary spending level of $1.07 trillion for the Appropriations committee to disburse.

    Upcoming Hearings
    On Tuesday, April 19th the House Energy and Commerce Health Subcommittee will hold a hearing on the "Medicare Access and CHIP Reauthorization Act of 2015: Examining Physician Efforts to Prepare for Medicare Payment Reforms.”

    Registration Deadline Nearing for 2016 Leadership and Advocacy Conference
    Limited Hotel Rooms Available
    May 15-18, 2016 in Washington, D.C.

    Don’t miss the opportunity to take your advocacy to the next level in this critical election year!

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    Already 126 legislator meetings have been scheduled for attendees on Tuesday, May 17 for ACEP’s Lobby Days, many with House and Senate leaders and members of key healthcare committees. Before heading to Capitol Hill for ACEP’s Lobby Day, attendees will hear from ACEP members Rep. Joe Heck (R-NV) and Rep. Raul Ruiz (D-CA), who will share their experiences as emergency physician/members of congress, provide insight into the health care agenda of Congress, and discuss the importance of physician involvement in policymaking and the political process.

    To read more about Dr. Heck’s campaign for the U.S. Senate and Rep. Ruiz’ re-election campaign to the U.S. House, please click on the following links:
    https://www.heck4nevada.us/ 
    http://www.drraulruiz.com/

    Wednesday, May 18 will be devoted to the Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    Congressional Dine-Arounds during LAC

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress during the LAC. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI), Rep. Peter Roskam (R-IL), Rep. Cathy McMorris Rodgers (R-WA), Rep. David Joyce (R-OH), Rep. Joe Heck for NV Senate and ACEP member Dr. Mark Plaster, candidate for congress in Maryland’s Third congressional district.

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.
  • Weekly Update, April 8, 2016

    The Senate returned to business this week from their two-week spring recess period. The House will return to business from on April 11.

    IN THIS ISSUE:

    Medical Innovation Package in the Senate
    ACEP joins effort to end ban on CDC gun violence research
    Register for the ACEP Leadership and Advocacy Conference

      
    Senate HELP Committee Approves Final Bills for Medical Innovation Package
    On Wednesday the Senate Health, Education, Labor and Pensions (HELP) Committee approved the last five in a package of bipartisan bills expected to serve as a companion to the House-passed “21st Century Cures Act.” The compilation of bills includes provisions aimed at helping the National Institutes of Health and Food and Drug Administration hire and retain talent, approving antibacterial drugs to treat serious medical conditions in limited populations, implementing a Precision Medicine Initiative and promoting the inclusion of minorities in clinical research and streamlining administrative requirements for NIH researchers and grant recipients.

    Senators continue to negotiate an NIH innovation fund as part of the package, which also includes legislation aimed at making electronic health records more interoperable and requiring makers of reusable medical devices to submit pre-marketing data to the FDA. As part of a coalition effort, ACEP has expressed concern with the bill’s information blocking provisions and recommended additional actions to improve interoperability.

    A final vote on this legislation is expected as early as next week. Both Chambers will then have to reconcile their differing versions of these packages, which could happen later this year or possibly in a lame duck session.

    Ending the Ban on CDC Gun Violence Research
    ACEP joined with 140 medical, scientific research and public health organizations, including the American Medical Association, American Public Health Association and the American Association for the Advancement of Science, to urge Congress to end the current restrictions on gun violence research and to fund this critical work at the Centers for Disease Control and Prevention (CDC). These calls echo the requests from 17 Senators and 53 members of Congress who recently urged for dedicated funds for the CDC to conduct research into the causes and prevention of gun violence.

    Since 1996, Congress has retained an amendment to the appropriations bill that has effectively blocked the CDC from carrying out research to better understand how to prevent gun violence. In addition to the ban, Congress also cut funding for gun violence research and, in 2011, extended the research restriction to the National Institutes of Health.

    The letter sent to the leadership of the Senate and House Appropriations Committees is available online.

    Still Time to Register for the 2016 Leadership and Advocacy Conference

    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    On Tuesday, May 17 before heading to Capitol Hill for ACEP’s Lobby Day, attendees will hear from ACEP members Rep. Joe Heck (R-NV) and Rep. Raul Ruiz (D-CA), who will share their experiences as emergency physician/members of congress, provide insight into the health care agenda of Congress, and discuss the importance of physician involvement in policymaking and the political process.

    To read more about Dr. Heck’s campaign for the U.S. Senate and Rep. Ruiz’ re-election campaign to the U.S. House, please click on the following links:
    https://www.heck4nevada.us/
    http://www.drraulruiz.com/

    Wednesday, May 18 will be devoted to the Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    Congressional Dine-Arounds during LAC
    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress during the LAC. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI), Rep. Peter Roskam (R-IL), Rep. Cathy McMorris Rodgers (R-WA), and Rep. David Joyce (R-OH).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.
  • Weekly Update, March 24, 2016

    The Senate will return to business on April 4 and the House will return on April 12 after their respective spring recess periods.
               
    In this Issue:

    • House Budget News
    • Judiciary Committee Looks at Medical Malpractice Legislation for Savings
    • House Committee Holds First Hearing on Opioid Crisis
    • White House Pushes States to Act on Opioid Crisis
    • ACEP Leadership and Advocacy Conference News
    • NEMPAC and the 2016 Elections

    Last week, the House Budget Committee approved a resolution that provides $1.07 trillion in discretionary spending for fiscal 2017, sticking to the topline figure Congress and the White House agreed to in October. The FY 2017 budget proposes to balance the federal budget within 10 years, achieve $6.5 trillion in savings, calls for a vote on a Balanced Budget Amendment this year, and requires consideration of legislation that would achieve at least $30 billion in automatic spending reductions and reforms in 2017-2018 and $140 billion over 10 years. Some of these savings would be derived from entitlement reforms, such as elimination of Affordable Care Act subsidies to help low-income individuals purchase insurance through a health exchange, as well as reduction of federal support for Medicaid and Medicare programs.

    Separate legislation would also be required to implement these cuts. Each House committee was asked by Speaker Paul Ryan (R-WI) to find savings in an effort to offset the spending increases in the budget deal and to help the House GOP unite around a budget blueprint for 2017.

    The House Energy and Commerce Committee and House Ways and Means Committee each approved bills last week that would enact proposals to achieve these cuts.

    This week, the House Judiciary Committee attempted to mark-up medical malpractice legislation, the “Help Efficient, Accessible, Low-cost, Timely Healthcare Act (H.R. 4771),” to achieve their committee’s cuts. The legislative proposal, based on a model enacted in California, would eliminate joint and several liability, provide for periodic payment of future economic damages and cap non-economic damages at $250,000, among other reforms. The Congressional Budget Office has estimated the legislation would save $44 billion over a ten year period. In 2012, identical legislation was passed out of the Judiciary committee. After some discussion, the mark-up was indefinitely postponed after the members adjourned for lack of quorum. Surprisingly, some Republicans lawmakers on the committee took issue with the bill arguing that tort reform is a states’ rights issue. A makeup date hasn’t been announced. The mark-up can be viewed here.

    House Committee Holds First Hearing on Opioid Abuse and Heroin Epidemic
    On Tuesday the House Oversight and Government Reform Committee held a hearing titled, “America’s Heroin and Opioid Abuse Epidemic.” Tuesday’s hearing was the first of many expected House hearings on the epidemic since the Senate passed a bill authorizing new federal treatment and prevention programs earlier this month. More information on the hearing can be found here.

    White House Pushes States Address Opioid Crisis
    The White House sent letters to every governor this week, highlighting best practices that states can take to address the prescription drug and heroin epidemic.

    The letters to the governors emphasized that many of the states' priorities for addressing the opioid crisis, presented by the National Governors Association in February, would be funded by the federal government if Congress approves the President’s budget request for an additional $1.1 billion to fight the epidemic. Most of the new money would go directly to states to expand access to medication-assisted treatment and counseling for patients with opioid use disorders.

    The 11 state best practices highlighted by the White House include requiring all prescribers to receive training on opioid prescribing. Only 14 states have laws requiring this training.

    Other best practices include permitting distribution of opioid-overdose reversal drug naloxone by pharmacists, and permitting third-party prescriptions of naloxone by pharmacists.

    The White House also offered suggestions for states to improve their Prescription Drug Monitoring Programs, including requiring PDMPs be used by all prescribers and requiring pharmacists to submit data to PDMPs within 24 hours. Only eight states require prescribers to consult PDMPs and only 22 states require pharmacies to submit their drug dispensing data to PDMPS.

    Late last week, HHS released the National Pain Strategy which further details the federal effort to improve how pain is prevented, assessed and treated in the United States. Also, President Obama will be the keynote speaker at the upcoming National Rx Drug Abuse and Heroin Summit on March 29 in Atlanta, Georgia.

    Register Today for the 2016 Leadership and Advocacy Conference
    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI), Rep. Peter Roskam (R-IL), and Rep. Cathy McMorris Rodgers (R-WA).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

    For more information or to register for LAC, please go to: http://www.acep.org/lac/.

    NEMPAC and the 2016 Elections
    NEMPAC is working hard to give emergency medicine a strong presence in the ongoing political discourse in this election cycle. You can see the candidates that have garnered NEMPAC's support and donors like you that make it possible by visiting the 2016 NEMPAC Election Center.

    Will you be attending the 2016 Leadership & Advocacy Conference (LAC) in Washington, DC this May? ACEP President Dr. Jay Kaplan is hosting a not to be missed NEMPAC VIP Reception at the Hay Adams Hotel rooftop. “Give-a-Shift” donors ($1200 annually, Residents $120) and “Sterling” donors ($600 to $1199, Residents $60) are invited to attend. Click here to find out more or to make your annual donation. You will need your ACEP member log-in credentials.

  • Weekly Update, March 18, 2016

    The Senate will take a two-week break until April 4. The House returns next week for a short week of business and will recess on March 24 until April 4.

    In this Issue:
    •Senate Committee Acts on Mental Health Reform
    •House Committee Advances Budget
    •House Committee Looks at MACRA Implementation
    •CDC Finalizes Opioid Prescribing Guidelines
    •ACEP Leadership and Advocacy Conference News
    •NEMPAC and the 2016 Elections

    Senate Committee Advances Mental Health Bill

    On Wednesday, the Senate Health, Education, Labor, and Pensions (HELP) Committee unanimously approved a bill (S. 2680) designed to improve mental health and substance abuse programs. The legislation was sponsored by Chairman Lamar Alexander (R-TN), Ranking Democrat Patty Murray (D-WA) and committee members Bill Cassidy (R-LA) and Chris Murphy (D-CT). It was a modification of an earlier, ACEP-supported bill (S. 1945) introduced by Cassidy and Murphy. However, in a letter to all HELP committee members, ACEP expressed its concerns regarding several of the provisions that were subsequently removed before committee consideration, such as support for Assisted Outpatient Treatment (AOT) programs, elimination of the Medicaid Institutions of Mental Disease (IMD) exclusion, and liability protections for federal health center volunteers, among other things. ACEP is urging lawmakers to include these important provisions in the bill before the end of the legislative process.

    The biggest hurdle to including the IMD exclusion is that it is expected to cost between $40 and $80 billion, depending on the specifics of the provision. During the committee mark-up, Sen. Susan Collins (R-ME) offered an ACEP-supported amendment to repeal the exclusion, but she ultimately withdrew it because a different Senate committee has jurisdiction over its funding. ACEP expects this amendment will be offered again when the bill is considered by the full Senate, which is currently scheduled for April. There is also the possibility that amendments related to firearm ownership may be offered at that time as well, although the inclusion of any such amendments may impede the legislation.

    The ACEP-supported House companion (H.R. 2646) has been stalled since the House Energy and Commerce Health Subcommittee approved it on November 4, 2015. It also faces similar financing and political challenges.

    House Committee Advances Budget, But Outcome Remains Uncertain

    Also on Wednesday, the House Budget Committee approved a 10-year spending plan for federal agencies and programs on a party-line vote of 20 to 16. The fiscal year 2017 budget proposes to balance the federal budget within 10 years, achieve $6.5 trillion in savings, calls for a vote on a Balanced Budget Amendment this year, and requires consideration of legislation that would achieve at least $30 billion in automatic spending reductions and reforms in 2017-2018 and $140 billion over 10 years. Some of these savings would be derived from entitlement reforms, such as elimination of Affordable Care Act subsidies to help low-income individuals purchase insurance through a health exchange, as well as reduction of federal support for Medicaid and Medicare programs.

    Separate legislation would actually be required to implement these cuts. The House Energy and Commerce Committee and House Ways and Means Committee each approved bills this week that would enact proposals to achieve these cuts. However, these measures are unrealistic given the almost certain opposition by Senate Democrats and the White House.

    Since House Speaker Paul Ryan (R-WI) is not pressuring his Republican colleagues to support the leadership-backed proposal or seeking support from Democrats to pass the budget on the House floor, it is unclear if he will even bring this measure up for a vote. This could create additional challenges for getting the annual appropriations bills enacted, although the Senate is considering skipping the budget debate altogether and instead going straight to appropriations (as permitted through a provision in last year's bipartisan budget deal).

    House Committee Looks at MACRA Implementation

    On Wednesday, the House Energy and Commerce Health Subcommittee held a hearing titled “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Examining Implementation of Medicare Payment Reforms.” The sole witness was Dr. Patrick Conway, Deputy Administrator for Innovation and Quality at CMS. The hearing focused on implementation of Medicare payment reforms in MACRA, including the repeal of the SGR, the temporary payment stabilization under the fee schedule, the creation of the Merit-Based Incentive Payment System (MIPS), and the work that CMS is undertaking to encourage value based payments that would qualify as an eligible APM. More information can be found here.

    CDC Finalizes Voluntary Guidelines for Opioid Prescribing

    This week, the Centers for Disease Control and Prevention (CDC) finalized its guidelines for primary care physicians prescribing opioids to adults for chronic pain in outpatient settings. The voluntary guidelines summarize scientific knowledge about the effectiveness and risks of long-term opioid therapy, and provide recommendations for when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up and discontinuation; and assessing risk and addressing harms of opioid use. They do not apply to cancer, palliative or end-of-life care.

    In a recent press release, ACEP president Jay Kaplan MD, FACEP, stated, “Emergency physicians see first-hand the tragic consequences of opioid misuse and addiction and applaud the Centers for Disease Control and Prevention for taking an important step forward in addressing this public health epidemic . . . Washington state's Emergency Department Information Exchange is a fine example of how these programs can work well, and we support the expansion of such systems . . . We reiterate our commitment to work together with the federal government, the public and the house of medicine to find lasting solutions to this scourge of the 21st century." The CDC Guidelines for Prescribing Opioids for Chronic Pain — United States, 2016 can be viewed here.

    Register Today for the 2016 Leadership and Advocacy Conference
    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.
    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI), Rep. Peter Roskam (R-IL), and Rep. Cathy McMorris Rodgers (R-WA).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

    For more information or to register for LAC, please go to: http://www.acep.org/lac/.

    NEMPAC and the 2016 Elections
    NEMPAC is working hard to give emergency medicine a strong presence in the ongoing political discourse in this election cycle. You can see the candidates that have garnered NEMPAC's support and donors like you that make it possible by visiting the 2016 NEMPAC Election Center.

    Will you be attending the 2016 Leadership & Advocacy Conference (LAC) in Washington, DC this May? ACEP President Dr. Jay Kaplan is hosting a not to be missed NEMPAC VIP Reception at the Hay Adams Hotel rooftop. “Give-a-Shift” donors ($1200 annually, Residents $120) and “Sterling” donors ($600 to $1199, Residents $60) are invited to attend. Click here to find out more or to make your annual donation. You will need your ACEP member log-in credentials.

  • Weekly Update, March 11, 2016

    Both the Senate and the House are in session next week. 

    Senate Approves Opioid Abuse Legislation
    On Thursday, the Senate overwhelmingly approved S. 524, the "Comprehensive Addiction and Recovery Act (CARA) of 2015," by a vote of 94 to 1. Sen. Ben Sasse (R-NE) was the lone dissenter, saying he wasn't sure fighting addiction was best addressed by the federal government. The bill, sponsored by Sens. Sheldon Whitehouse (D-RI) and Rob Portman (R-OH), essentially reallocates funds to new opioid education, prevention and treatment programs, as well as expand naloxone availability for first responders, prescription drug disposal sites and PDMPs, among other things.

    Despite the overwhelming vote on final passage, many Senate Democrats continue to criticize the Republican majority for not agreeing to an amendment offered earlier by Sen. Jeanne Shaheen (D-NH) that would have added $600 million in emergency funding for opioid abuse programs. However, Senate Majority Leader Mitch McConnell (R-KY) has argued that there's roughly $400 million available through last year's omnibus appropriations bill that could be directed to CARA.

    The House companion legislation, H.R. 953, currently has 92 co-sponsors but hasn't been scheduled for review by any of the three committees of jurisdiction (Judiciary, Energy and Commerce, and Education and Workforce) yet.

    On a related note, HHS Secretary Sylvia Burwell today announced nearly $100 million in grant money will be made available to more than 270 federal health centers to fight opioid abuse. The grants will be administered by HHS' Health Resources and Services Administration (HRSA) and will range from $200,000 to more than $400,000.

    Senate Mental Health Bill Set for Committee Consideration
    Earlier this week, the chairman and ranking member, Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), respectively, of the Senate Health, Education, Labor and Pensions (HELP) Committee released a draft bill to reform and update mental health programs in the U.S. The bill contains many provisions from the ACEP-supported "Mental Health Reform Act of 2015," sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT). However, several of the more meaningful provisions, such as support for state Assisted Outpatient Treatment (AOT) programs, eliminating the Medicaid Institutions of Mental Disease (IMD) exclusion, liability protections for volunteers at community health centers and community behavioral health centers, etc., were excluded from this draft. ACEP is urging senators to add these key provisions before the end of the legislative process.

    The HELP Committee is scheduled to consider the Alexander-Murray bill on Wednesday, as well as several proposals related to opioid abuse, including reauthorization of the National All Schedules Prescription Electronic Reporting (NASPER) Act, lifting the cap on a physician's ability to prescribe maintenance or detoxification treatment drugs from 30 to 100 (allowed to request no cap after one year if certain conditions are met), and establishing co-prescribing guidelines (writing prescriptions for an opioid and naloxone at the same time) in federal health care programs or medical facilities.

    Senate Advances Debate on Biomedical Innovations Bill
    The Senate HELP Committee approved seven bills this week as part of a broader biomedical reform package it is crafting as a counterpart to the House-passed "21st Century Cures Act" (H.R. 6). The committee previously approved a set of biomedical reform bills in February and it is expected to consider additional legislation during an April mark-up as well. A final bill is expected on the Senate floor early this summer. However, both Democrats and Republicans have disputes over how to pay for the bill's provisions. For a list of bills included in the mark-ups, please click here.

    Upcoming Congressional Oversight Hearings
    On Wednesday, March 16 the House Ways and Means Health Subcommittee will hold a hearing titled "Preserving and Strengthening Medicare."

    On Thursday, March 17 the Energy and Commerce Health Subcommittee has scheduled a hearing entitled "Medicare Access and CHIP Reauthorization Act of 2015: Examining Implementation of Medicare Payment Reforms."

    ACTION ALERT
    Follow this link to ask your U.S. Legislator to Co-Sponsor H.R.4365, the "Protecting Patient Access to Emergency Medications Act of 2016," which would codify the current practice of allowing EMS medical directors to use standing orders for EMTs and paramedics when administering controlled substances, allow a single EMS agency registration (rather than for each location), etc. You will need your ACEP log-in credentials to "Take Action" on this issue.

    Register Today for the 2016 Leadership and Advocacy Conference
    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI) and Rep. Peter Roskam (R-IL).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

    For more information or to register for LAC, please go to: http://www.acep.org/lac/.

  • Weekly Update, March 4, 2016

    House lawmakers start a week-long recess today, with Republicans still at an impasse over the next budget resolution. The Senate will return next week to try to complete work on a measure designed to combat the nation’s heroin and opioid addiction epidemic before the Easter recess. (See story below)

    Opioid Legislation Delayed in Senate
    This week, the full Senate began its consideration of S. 524, the "Comprehensive Addiction and Recovery Act (CARA) of 2015," sponsored by Sens. Sheldon Whitehouse (D-RI) and Rob Portman (R-OH). Essentially, the bill would authorize the Obama Administration to reallocate roughly $80 million in funds to new opioid education; prevention and treatment programs, including expanded expand availability of naloxone for first responders, prescription drug disposal sites and PDMPs, among other things. The legislation was approved by the Senate Judiciary Committee on Feb. 22 and has more than 40 bi-partisan co-sponsors and the support of more than 130 advocacy groups. However, soon after the committee completed its review, it was criticized by Senate Democratic leaders for not providing more funding, which was recently echoed by the White House.

    Although more than 100 amendments to CARA were filed by Senate Democrats and Republicans, only a few were actually considered this week. The two most notable amendments were offered by Sen. Jeanne Shaheen (D-NH), which would have provided $600 million in emergency funding, thus not subject to a budget off-set, and Sen. Pat Toomey (R-PA), which would establish a Medicare pharmacy and physician lock-in to help prevent doctor shopping by drug seekers. The Shaheen Amendment failed by a vote of 48 to 47 on a budget point of order that required 60 votes for approval. The Toomey Amendment was agreed to by voice vote.

    Senate Majority Leader Mitch McConnell (R-KY) was negotiating throughout the week with Senate Minority Leader Harry Reid (D-NV) on the number and type of amendments that would be considered. After failing to reach an agreement yesterday to consider more than a dozen additional amendments, Sen. McConnell filed a motion to end debate on the final two amendments and the underlying bill. Those votes are scheduled for Monday evening.

    New House Budget Proposal Rejected
    The House Budget Committee, which tentatively planned to send a proposal to the House for approval by the end of February, was forced to postpone the introduction of its fiscal year 2017 proposal until the end of March because a majority of House Republicans expressed their disapproval of the deal struck last year between former Speaker John Boehner (R-OH) and President Obama. These individuals are demanding $30 billion be cut from the agreed upon spending plan in order to off-set the increase in spending slated for the coming year.

    Yesterday, House Speaker Paul Ryan (R-WI) presented a revised version of the FY 17 budget to House Republicans that sought to reach that goal by sticking to the underlying agreement from last year, but then seeking unspecified cuts to mandatory entitlement programs (i.e. Medicare, Medicaid, Social Security, etc.). According to news sources, this plan was widely rejected by both members seeking steeper reductions in domestic programs and by members seeking additional funding for defense programs. Given these objections, a budget proposal that satisfies all critics is unlikely and it increases the odds that Congress will have to fund the federal government through a temporary, Continuing Resolution, which will delay action until after the November elections. Lawmakers headed home for the weekend and will return to much activity with the scheduled release of the White House budget proposal and the New Hampshire primary on Tuesday. The Senate will return with votes beginning on Monday evening and the House returns Tuesday at 2 p.m. and will vote at 6:30 p.m.

    In Case You Missed It
    An audio recording of the ACEP Teleforum on legislation to allow and protect EMS standing orders held on Wednesday, February 10 is now available here

    ACEP President Jay Kaplan, MD, FACEP, staff for Rep. Richard Hudson (R-NC), and Dr. Craig Manifold, Chair of ACEP’s EMS Committee discussed Rep. Hudson’s bi-partisan legislation H.R. 4365, the “Protecting Patient Access to Emergency Medications Act of 2016,” which would clarify and protect the current practice of “standing orders” by physician medical directors overseeing care provided in the field by paramedics and other EMS practitioners. Pending DEA regulations threaten these practices and legislative action is needed to ensure that patients do not see any disruption in the provision of this critical and lifesaving care.

    ACTION ALERT
    Follow this link to ask your U.S. Legislator to Co-Sponsor H.R.4365 and to learn more about this critical issue. You will need your ACEP log-in credentials to "Take Action" on this issue.

    Register Today for the 2016 Leadership and Advocacy Conference
    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT), Rep. Jim Langevin (D-RI) and Rep. Peter Roskam (R-IL).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

    For more information or to register for LAC, please go to: http://www.acep.org/lac/.

    CMS Revalidation Update
    New regulatory requirement involving Medicare reimbursement! As of March 1, 2016 the Center for Medicare Services (CMS) has rolled out a new process for revalidation. This is incredibly important to comply with as it can have a huge impact on your reimbursement through Medicare. As a reminder, this is the second cycle of revalidation required for Medicare compliance under the Affordable Care Act. CMS has attempted to make the process simpler by having due dates available online.

    Some key facts:

    • DME suppliers must revalidate every 3 years, all other providers (including physicians) every 5 years
    • Early revalidations will not be taken for any provider
    • Failure to comply will result in a gap in Medicare payments (no grace periods after deadlines)

    If you have already completed this process under cycle one, you are covered until your next scheduled revalidation (in 3-5 years). Please check with your group to make sure you are revalidated on time and do not miss Medicare payments. For more information, check the CMS Revalidation Presentation, located halfway down the page, or visit their website.

    If you have any questions or concerns please contact Ms. Barbara Tomar, ACEP’s Federal Affairs Director, at btomar@acep.org.

  • Weekly Update, February 26, 2016

    The House and Senate are in session next week. House chairmen will be spending the next few days assembling a package of mandatory spending cuts in an effort to win conservatives' support for a budget resolution. The Senate has plans to move next week on legislation addressing the opioid epidemic.

    Senate Committees Hold Opioid Abuse Hearings
    On Tuesday the Senate Finance Committee held a hearing titled, “Examining the Opioid Epidemic: Challenges and Opportunities." The hearing examined legislative proposals designed to reduce opioid misuse. Issues discussed during the hearing included allowing pharmacy lock-ins (requirement that an individual use one pharmacy for all prescription medications) for Medicare Part D plans, greater responsibility in drug marketing, prescribing guidelines, and strengthening enforcement as well as provision of social services. For further details on the hearing, please click here.

    Also this week the Senate Special Aging Committee held a hearing titled, “Opioid Use among Seniors – Issues and Emerging Trends.” For further information on the hearing please click here.

    Organizations Urge Congress to Support PDMPs
    Earlier this week, ACEP, along with the AMA and many other stakeholders, sent a joint letter to the House and Senate leadership expressing our support for H.R. 1725/S. 480, the “National All Schedules Prescription Electronic Reporting Reauthorization Act” (NASPER). The primary goal of NASPER is to modify and reauthorize federal grants to states for controlled substance monitoring programs, also known as Prescription Drug Monitoring Programs (PDMPs). The House approved its version of the legislation (H.R. 1725) by voice vote on Sept. 8, 2015, but the Senate has yet to take action.

    PDMPs are an important element of many proposals to address the prescription drug abuse epidemic.

    In addition to supporting these programs, ACEP is monitoring state and local emergency department initiatives to decrease opioid prescribing and use. Examples of these programs include the state Emergency Department Information Exchange (EDIE’s) in Washington, Oregon and California as well as efforts in New Jersey to use alternative, non-opioid pain management protocols supplemented with patient support networks.

    ACEP continues to work with other medical specialties, as well as the American Medical Association (AMA) Task Force to Reduce Opioid Abuse, CDC, FDA and the White House Office of Drug Control Policy to find meaningful and multi-faceted solutions to the opioid epidemic.

    House Committees Begin Review of HHS Budget
    This week, the House Energy and Commerce Health Subcommittee and the House Labor-HHS-Education Appropriations Subcommittee both hosted hearings with U.S. Health and Human Services Secretary Sylvia Burwell to discuss the department's fiscal year 2017 budget, among other things. Not surprisingly, Republicans generally used these hearings as an opportunity to criticize Obama Administration policies while Democrats expressed their support for those policies.

    Senate HELP Committee to Address Mental Health Legislation in March
    The Senate HELP Committee is scheduled to mark up a broad bipartisan mental health and substance abuse bill on March 16. The measure, crafted by Senator Alexander (R-TN), ranking member Sen. Patty Murray (D-WA) and other committee members, has not yet been introduced. The bill is expected to address mental health workforce shortages, opioid abuse, and how Medicaid pays for behavioral health, among other things. Their bill is also expected to absorb components of an ACEP-supported mental health reform bill sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT). That bill will not be marked up independently. The HELP legislation could be packaged with mental health reform bills awaiting mark ups in the Senate Judiciary and Finance Committees.

    Senate Confirms FDA Commissioner
    The Senate on Wednesday voted 89-4 to confirm Dr. Robert Califf as the FDA commissioner. The FDA had been without a confirmed commissioner since Margaret Hamburg stepped down a year ago in March 2015. In September, President Obama nominated Califf, a cardiologist who served as deputy FDA commissioner for medical products and tobacco. A handful of Senators attempted but failed to block Califf’s confirmation over disagreements with the agency's approval process for opioids.

    ED Visits Continue to Educate Legislators on Emergency Medicine Priorities
    As we approach the 2016 elections in November, ACEP’s goal is to continue to educate legislators and their staff on the challenges faced every day by our members in providing quality, timely care to patients across the country. Thanks to help from 911 Network Members, we are ensuring that the issues that matter most to our specialty are front-and-center in the minds of legislators who make decisions on critical health care policy.

    Thank you to the following ACEP members who have taken time to conduct these tours recently:

    • Dr. John Henner for State Senator Michael Roberson at St. Rose Medical Center in Henderson, NV. Mr. Roberson is a republican candidate for Nevada’s 3rd Congressional district, currently held by ACEP Member Rep. Joe Heck (R-NV) who is running for the U.S. Senate.
    • Dr. Daniel Wehner for Rep. Keith Rothfus (R-PA) at Memorial Medical Center in Johnstown, PA.
    • Dr. Douglas Ross and Dr. Gene Shelby for Rep. Bruce Westerman (R-AR) at St. Vincent Hospital in Hot Springs, AR.


    Rep. Bruce Westerman visiting the St. Vincent Hospital ED.

    On the political side, our NEMPAC Board of Trustees is busy vetting candidates worthy of NEMPAC’s support in the 2016 elections. In 2015, NEMPAC collected $1,052,070 from ACEP members across the country and remains one of the top medical specialty PACs in the nation. Many candidates including incumbents, open seat and challengers are reaching out for our support in this highly competitive and expensive election season.

    NEMPAC donors around the country also have the opportunity to attend local fundraising events for NEMPAC supported candidates and hand deliver a contribution on behalf of thousands of ACEP members around the country. Most recently, emergency physicians participated in the following events:

    • Dr. Arlo Weltge and Dr. Neil Gandhi for Rep. John Culberson (R-TX)
    • Dr. Compton Broders for Rep. Michael Burgess (R-TX)
    • Dr. Nathan Schlicher for Rep. Denny Heck (D-WA)
    • Dr. David Milbrandt for Rep. Erik Paulsen (R-MN)
    • Dr. John Bibb and Dr. Fed Dennis for Rep. Ted Lieu (D-CA)
    • Dr. Bing Pao for Rep. Juan Vargas (D-CA)
    • Dr. Christopher Kang for Rep. Cathy McMorris Rodgers
    • Dr. Laura Pimentel for Rep. Dutch Ruppersberger (D-MD).
    NEMPAC donors also help us evaluate new candidates running for office by meeting with them in their districts and educating them about the specialty.

    Visit the NEMPAC Website for more information on ACEP’s political activities in this critical election year.

    Register Today for the 2016 Leadership and Advocacy Conference
    May 15-18, 2016 in Washington, D.C.

    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    Highlights include political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal and a panel of physician leaders including ACEP President Jay Kaplan, MD, FACEP, AHA President and CEO Rick Pollack, and AMA President Steve Stack, MD, FACEP.

    NEMPAC will again be hosting Congressional Dine-Arounds for key members of congress. Join you emergency physician colleagues and some of the most influential lawmakers while dining in our nation’s capital. A minimum donation to the Member of Congress’ campaign is suggested for participation, which will be combined with the support provided by NEMPAC.

    Confirmed legislators include Rep. Michael Burgess (R-TX), Rep. Richard Hudson (R-NC), Senator Richard Blumenthal (D-CT) and Rep. Peter Roskam (R-IL).

    For additional information, contact ACEP Political Affairs Director Jeanne Slade at jslade@acep.org.

    For more information or to register for LAC, please go to: http://www.acep.org/lac/.
  • Weekly Update, February 12, 2016

    Congressional Schedule
    Both the House and Senate are in President’s Day recess for the week and will return to session on Monday, February 22nd. 

    ACEP Teleforum on EMS Standing Orders
    On Wednesday, ACEP hosted its third in a series of teleforum conference calls on issues of importance to emergency medicine. The call focused on H.R. 4365, the "Protecting Patient Access to Emergency Medications Act of 2016," sponsored by Rep. Richard Hudson (R-NC), and was moderated by ACEP president Jay Kaplan, MD, FACEP. The call also featured Rep. Hudson's health policy expert, Preston Bell, and ACEP's EMS Committee chair Craig Manifold, DO, FACEP. The legislation seeks to codify the current practice of allowing EMS medical directors to use "standing orders" for EMTs and paramedics when administering controlled substances; permits EMS agencies to directly register with the DEA (instead of through the medical director); updates receipt, movement and storage rules for EMS agency controlled substances; ensure every EMS agency has at least one physician medical director; and allow a single EMS agency registration (rather than for each location).

    At the conclusion of the teleforum, Dr. Kaplan urged participants to use ACEP's Advocacy website to immediately contact their Representative. Once there, click on the "Take Action" button and follow the instructions. You will need your ACEP log-in credentials.

    President's FY 2017 Budget D.O.A.
    Earlier this week, President Obama released his $4.1 trillion fiscal year 2017 budget proposal . The request includes a long list of ideas that have little chance of becoming law in a Republican-controlled Congress. The proposal contains several health-related provisions pertaining to Medicaid, the Cadillac Tax, prescription drugs, healthcare research and emergency virus funding. The HHS portion of the president's budget also proposes to end out-of-network balance billing, which corresponds with legislation (H.R. 3770) introduced last year by Rep. Lloyd Doggett (D-TX). However, leaders of the House and Senate budget panels have dismissed the budget plan outright and stated they will not even hold hearings on the President’s proposal.

    Senate Committee Advances Opioid Bill
    Yesterday, the Senate Judiciary Committee unanimously approved S. 524, the "Comprehensive Addiction and Recovery Act of 2015," sponsored by Sens. Sheldon Whitehouse (D-RI) and Rob Portman (R-OH). Essentially, the bill would authorize the Obama Administration to use current funds to give states and organizations grants for opioid education, prevention and treatment. In addition to expanding prevention and education efforts, the bill would expand the availability of naloxone to first responders, expand disposal sites for unwanted prescription medications, and strengthen prescription drug monitoring programs (PDMPs), among other things. The full Senate is likely to consider S. 524 when they return from the upcoming recess.

    Some Senate Democrats criticized the bill for not providing appropriate funding to carry out these initiatives. Sen. Jeanne Shaheen (D-NH) intends to offer an amendment to the bill, based on her previously introduced legislation (S. 2423), which would provide $600 million in emergency funding for the HHS and DOJ programs. Included in that funding would be $250 million in substance abuse prevention and treatment block grants; $200 million to the Department of Justice to fund local and state initiatives for prevention, treatment, enforcement and education programs; $50 million to support work on PDMPs, interventions and rapid response projects; $25 million for state drug task forces; $5 million to assist community organizations and develop statewide networks for peer-to-peer recovery support; and emergency funding for other heroin and opioid programs.

    More on Mental Health
    Earlier this week, Sens. Debbie Stabenow (D-MI) and Roy Blunt (R-MO) introduced ACEP-supported legislation, the "Expand Excellence in Mental Health Act" (S. 2525), to increase funding for the program they originally championed in 2014. The law, which was part of the MACRA/SGR repeal legislation, currently provides eight states with grants to fund comprehensive community behavioral health services. S. 2525 will expand that funding to 24 states.

    A House version of the legislation is expected to be introduced in the coming weeks by Reps. Leonard Lance (R-NJ) and Doris Matsui (D-CA). Click through to view ACEP’s letters of support to the House and Senate

    Other Washington News
    While in Washington, Dr. Kaplan and new board members had the opportunity to attend NEMPAC events for Rep. Chris Collins (R-NY) and Rep. Jared Huffman (D-CA). 


    Dr. Mark Rosenberg, Dr. Becky Parker, Rep. Chris Collins (R-NY), Dr. Jay Kaplan, and Dr. Christopher Kang at a NEMPAC fundraiser.   


    Dr. Kaplan meets with Rep. Jared Huffman (D-CA). 

    Registration Now Open for the 2016 Leadership and Advocacy Conference
    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    We’ve brought in the Nation’s experts to lead our discussions. Monday's luncheon will feature political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal.

    For more information or to register, please go to: http://www.acep.org/lac/.
  • TeleForum Reminder, February 9, 2016

    ACEP TELEFORUM ON “LEGISLATION TO ALLOW & PROTECT EMS STANDING ORDERS” 
    ____________________________________________________________

    If you haven't already, please Register for ACEP's TeleForm on EMS Standing Orders Legislation 
    Wednesday, February 10 at 3:30 pm ET

    ACEP will host a special teleforum tomorrow to discuss legislation that would clarify and protect the current practice of “standing orders” by physician medical directors overseeing care provided in the field by paramedics and other EMS practitioners. Pending DEA regulations threaten these practices and legislative action is needed to ensure that patients do not see any disruption in the provision of this critical and lifesaving care.

    ACEP President Jay Kaplan, MD, FACEP will moderate the call and our special guests will be Rep. Richard Hudson (R-NC) who will discuss his bi-partisan legislation H.R. 4365, the “Protecting Patient Access to Emergency Medications Act of 2016,” and Dr. Craig Manifold, Chair of ACEP’s EMS Committee.

    Please follow this link to register and for more information.
    ____________________________________________________________

    If you are unable to join the call, but are ready to "Take Action" on the issue, please use your ACEP log-in credentials on the ACEP Advocacy website to
    urge your legislator to support H.R. 4356

    If you're having trouble accessing these links, please contact Gabrielle Szlenkier at
    (202) 728-0610 ext. 3020 or gszlenkier@acep.org.

  • Weekly Update, February 5, 2016

    Lawmakers headed home for the weekend and will return to much activity with the scheduled release of the White House budget proposal and the New Hampshire primary on Tuesday. The Senate will return with votes beginning on Monday evening and the House returns Tuesday at 2 p.m. and will vote at 6:30 p.m.

    President to Propose Nearly $1.1 billion to Fight Opioid Abuse
    President Obama’s fiscal year 2017 budget request will include nearly $1.1 billion in new funding to address prescription opioid abuse and heroin use, the White House announced on Tuesday.

    ACEP continues to work with other medical specialty groups to find meaningful and multi-faceted solutions to the opioid epidemic. As previously mentioned in a January Weekly Update, ACEP President Dr. Jay Kaplan attended a White House meeting to discuss the opioid epidemic and how physician groups are responding to this crisis. Dr. Kaplan outlined ACEP's efforts to educate its members on opioid prescribing guidelines and shared the results of the 2015 American Journal of Preventive Medicine (AJPM) study that showed the largest percentage drop in opioid-prescribing rates between 2007-2012 occurred in emergency medicine (-9%). During that same period of time, physical medicine/rehabilitation specialists increased opioid prescribing by 12%; internal medicine opioid prescribing increased by 5.6% and family practice opioid prescribing increased by 5.6%.

    In addition, Dr. Kaplan discussed improvements in prescribing through the Emergency Department Information Exchange (EDIE) in Washington state and Oregon; asked for consideration to use opioid prescribing practices signs in the emergency department (disallowed previously by CMS); and expressed ACEP's support for Prescription Drug Monitoring Programs (PDMPs), although he recommended the data by pushed to, rather than pulled by, healthcare providers.

    The White House proposal includes $1 billion in new mandatory funding over two years to expand access to medication-assisted treatment in states; access to substance use treatment providers through the National Health Services Corps; and to evaluate and improve treatment for patients with opioid use disorders. Some funding would be allocated to the departments of Justice and HHS to prevent overdoses, increase access to medication-assisted treatment and the overdose-reversal drug naloxone, and support enforcement activities.

    In related news, the FDA on Thursday announced that, in response to the nation's opioid abuse epidemic, it will change its policies on reviewing new painkillers, and will carefully consider any new labeling for pediatric use of the drugs. The agency said it was "reexamining the risk-benefit paradigm for opioids." A press release announcing the new approach said the FDA needed to consider opioids' wider public health effects.

    As initial steps, the FDA vowed to: consult with independent advisory panels prior to the approval of some new pain relievers; improve access to naloxone; and provide medication-assisted treatment options for patients with opioid addictions, among other objectives.

    PLEASE REGISTER TODAY FOR THE ACEP TELEFORUM
    “LEGISLATION TO ALLOW & PROTECT EMS STANDING ORDERS”
    Wednesday, February 10 at 3:30 pm ET

    ACEP will host a special teleforum to discuss legislation that would clarify and protect the current practice of “standing orders” by physician medical directors overseeing care provided in the field by paramedics and other EMS practitioners. Pending DEA regulations threaten these practices and legislative action is needed to ensure that patients do not see any disruption in the provision of this critical and lifesaving care.

    ACEP President Jay Kaplan, MD, FACEP will moderate the call and our special guests will be Rep. Richard Hudson (R-NC) who will discuss his bi-partisan legislation H.R. 4365, the “Protecting Patient Access to Emergency Medications Act of 2016,” and Dr. Craig Manifold, Chair of ACEP’s EMS Committee.

    Please follow this link to register and for more information.

    ACTION ALERT
    Follow this link to ask your U.S. Legislator to Co-Sponsor H.R.4365 and to learn more about this critical issue. You will need your ACEP log-in credentials to "Take Action" on this issue.

    House Democrats Introduce Mental Health Bill
    Early this week, key House Democrats from the Energy & Commerce committee introduced their own mental health reform legislation. ACEP is in the process of reviewing the proposal to identify policies that ACEP can support or potentially seek to modify. While it is possible the full committee could mark-up H.R. 2646 before the end of the month, it is more likely that action will occur later this spring. To learn more about the recent proposal, click here.

    In conjunction, the Senate HELP Committee continues to hold hearings on mental health, but no date has been announced for the committee to formally consider the ACEP-supported S. 1945, the "Mental Health Reform Act of 2015," sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT). At a recent mental health hearing, Chairman Lamar Alexander (R-TN) suggested it would be on the committee docket once they act on their version of the 21st Century Cures legislation (and possibly a higher education bill). The Senate approved a less comprehensive mental health bill, the "Mental Health Awareness and Improvement Act of 2015" (S. 1893), sponsored by Sen. Alexander and the Ranking Democrat on HELP, Sen. Patty Murray (D-WA), on Dec. 18. There has also been some discussions about incorporating at least some of the provisions from S. 2002, the "Mental Health and Safe Communities Act of 2015," sponsored by Sen. John Cornyn (R-TX), into whatever bill advances through the HELP committee. To view ACEP’s positions on mental health reform, click here.

    House Fails to Override Presidential Veto on ACA Repeal
    The House on Tuesday failed to override a veto from President Obama striking down a bill that repealed key provisions of the Affordable Care Act and placed a one-year moratorium on federal funding for Planned Parenthood. The vote of 241-186 fell short of the 285 votes needed (two-thirds majority) to override the president’s veto of the legislation, which he issued Jan. 8. The bill marked the first time that legislation rolling back parts of Obamacare passed both chambers of Congress. Because the veto override stalled in the House, the Senate cannot consider the measure. At a recent meeting with GOP leadership, ACEP learned the Republicans have established a healthcare task force to further develop alternative policy to the Affordable Care Act. With election year politics in full force, a timeline for an alternative is unclear in addition to whether it will be a framework or actual legislation.

    Registration Now Open for the 2016 Leadership and Advocacy Conference
    Take your advocacy to the next level in this critical election year! The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    We’ve brought in the Nation’s experts to lead our discussions. Monday's luncheon will feature political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal.

    For more information or to register, please go to: http://www.acep.org/lac/

  • ACTION ALERT, February 3, 2016

    ACTION ALERT!
    EMS Standing Orders Threatened by Pending DEA Rule


    Pending federal regulations threaten a longstanding practice allowing EMS personnel to administer controlled substances to patients.

    This practice will soon be prohibited unless the Controlled Substance Act is amended.

    Urge your U.S. Legislator to Co-Sponsor H.R. 4365, the “Protecting Patient Access to Emergency Medications Act."

    H.R. 4365, bi-partisan legislation recently introduced by Rep. Richard Hudson (R-NC), would amend the Controlled Substance Act to allow EMS Agencies to continue using standing orders from their medical director for the delivery and administration of a controlled substance (Schedule II -V).

    Follow the link to ask your U.S. Legislator to Co-Sponsor H.R.4365 and to learn more about this critical issue.
    ______________________________________________________________________________

    REMINDER – MARK YOUR CALENDAR
    “ACEP TELEFORUM” ON “THREAT TO EMS STANDING ORDERS”

    Wednesday, February 10 at 3:30 pm ET

    ACEP will be hosting a special tele forum to provide more details about the DEA regulation that threatens EMS Standing Orders and legislation in Congress to address this issue.

    Our special guest will be Rep. Richard Hudson (R-NC) who will discuss his bi-partisan legislation (H.R. 4365).


    ACEP President Jay Kaplan, MD, FACEP, will moderate the call and ACEP Public Affairs Division staff will provide additional information. You will automatically receive a call at 3:30 pm eastern time on February 10 at the home telephone that we have on record for you in the ACEP database. Since we are not permitted to contact your cell phone without express permission, we will provide a link later this week where you can register for the call to provide an alternate number as well.

    You will be prompted to stay on the call and will have the opportunity to ask questions during the call.

    If you are having trouble accessing the ACEP Advocacy website, please contact Gabrielle Szlenkier at (202) 728-0610 ext. 3020 or gszlenkier@acep.org.

  • Weekly Update, January 29, 2016

    Next Week
    The "Snowzilla" storm that hit the nation's capital at the end of last week wreaked havoc on the congressional schedule. The House was only going to be in session for the first few days of the week anyway, due to the House Democratic strategy retreat in Baltimore, so they canceled activities for the entire week. The Senate pushed its schedule back and started its compressed week on Wednesday. Due to these postponements, the House moved its vote on overriding President Obama's veto of the reconciliation bill, which would essentially repeal the Affordable Care Act, next week.

    TeleForum to Discuss House Bill on EMS Standing Orders
    A few weeks ago, the Weekly Update reported on new legislation to address pending federal regulations that would threaten a longstanding practice that has allowed Emergency Medical Services (EMS) personnel to administer controlled substances to patients who are suffering from severe pain or experiencing seizures, for example. The bipartisan legislation, “Protecting Patient Access to Emergency Medications Act” (H.R.4365), will allow EMS personnel to continue the longstanding practice of administering approved medications to their patients under the guidance of the EMS agency's medical director.

    Stay tuned for further information on this issue which will be offered through an ACEP TeleForum on Wednesday, February 10 at 3:30 pm EST. Our guest will be the sponsor of H.R.4365, Rep. Richard Hudson (R-NC).  911 Members will also be asked to send an “Action Alert” to their legislators on the issue.

    Click here to see ACEP's Press Release

    ACEP Members Host ED Visits for Legislators

    As we approach the 2016 elections in November, ACEP’s goal is to continue to educate legislators and their staff on the challenges faced every day by our members in providing quality, timely care to patients across the country. Thanks to help from 911 Network Members, we are ensuring that the issues that matter most to our specialty are front-and-center in the minds of legislators who make decisions on critical health care policy.

    Over the next several months, we will continue to schedule ED tours with the help of Soapbox Consulting with key members of congress and candidates seeking our support for the first time. These visits are often the beginning of mutually beneficial relationships founded on trust, good information, and community ties and they are an integral part of ACEP’s advocacy strategy that includes action on the political, legislative and regulatory fronts.

    Thank you to the following ACEP members who have taken time to conduct these tours recently:

    • Dr. Dale Woolridge for Rep. Martha McSally (R-AZ) at Banner – University Medical Center in Tucson
    • Dr. Wes Zeger for Shelly Blake, Deputy Chief of Staff, and Kari Ridder, State Policy Director, for Senator Ben Sasse (R-NE) at the University of Nebraska Medical Center in Omaha
    • Dr. John Hafner for Rep. Cheryl Bustos (D-IL) at OSF Saint Francis Medical Center in Peoria


    Dr. Dale Woolridge and staff with Congresswoman Martha McSally (R-AZ) at at Banner – University Medical Center.


    Dr. Ryan Stanton and staff with Congressman Andy Barr (R-KY) at Baptist Health Lexington.

    ACEP Members Stay Active in NEMPAC
    On the political side, our NEMPAC Board of Trustees is busy vetting candidates worthy of NEMPAC’s support in the 2016 elections. In 2015, NEMPAC collected a record $1,052,070 from ACEP members across the country and remains one of the top medical specialty PACs in the nation. Many candidates, including incumbents, open seats and challengers, are reaching out for our support in this highly competitive and expensive election season. 

    NEMPAC donors around the country also have the opportunity to attend local fundraising events for NEMPAC-supported candidates and hand deliver a contribution on behalf of thousands of ACEP members around the country. Most recently, emergency physicians participated in the following events:

    • Dr. Peter Jacoby for Sen. Richard Blumenthal (D-CT)
    • Dr. Vikant Gulati for Rep. Ami Bera (D-CA)
    • Dr. Arvind Venkat for Rep. Mike Kelly (R-PA)
    • Dr. Marilyn Heine for Sen. Pat Toomey (R-PA)

    NEMPAC donors also help us evaluate new candidates running for office by meeting with them in their districts and educating them about the specialty.


    Dr. Marilyn Heine with Senator Patrick Toomey (R-PA) at a NEMPAC-supported fundraiser.


    Dr. Russ Kridel, Dr. Arlo Weltge, Congressman John Culberson (R-TX), and Dr. Neil Gandhi at a NEMPAC-supported fundraiser.

    Registration Now Open for the 2016 Leadership and Advocacy Conference
    The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    We’ve brought in the Nation’s experts to lead our discussions. Monday's luncheon will feature political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal

    When Charlie Cook makes a pronouncement based on his analysis of the political scene in America, people who want to be “in the know” sit up and listen. For more than two decades he has been Washington’s most trusted – and most accurate – voice on all things political, whether it’s the outcome of a Congressional, gubernatorial, or presidential election.

    For more information or to register, please go to: http://www.acep.org/lac/

    Follow us on Facebook and Twitter
    Stay up-to-date on the latest advocacy activities and check out recent photos of fellow 911 Network Members on our social media pages.

    • Facebook: ACEP Advocacy
    • Twitter: @ACEPAdvocacy 
  • Weekly Update, January 22, 2016

    Congressional Schedule
    The House returns next week and both chambers are scheduled to be in session but the massive snowstorm hitting the east coast this weekend has put activity in Washington DC on a temporary hold. Stay tuned.

    ACEP Participates in White House Meeting on Opioid Abuse
    On Thursday, ACEP president Dr. Jay Kaplan attended a meeting at the White House to review the opioid epidemic and how physician groups are responding to this crisis. Dr. Kaplan discussed ACEP's efforts to educate its members on opioid prescribing guidelines and shared the results of the 2015 American Journal of Preventive Medicine (AJPM) study that showed the largest percentage drop in opioid-prescribing rates between 2007-2012 occurred in emergency medicine (-9%). During that same period of time, physical medicine/rehabilitation specialists increased opioid prescribing by 12%; internal medicine opioid prescribing increased by 5.6% and family practice opioid prescribing increased by 5.6%.

    ACEP President Jay Kaplan at the White House on Thursday

    In addition, Dr. Kaplan discussed improvements in prescribing through the Emergency Department Information Exchange (EDIE) in Washington and Oregon; asked for consideration to use opioid prescribing practices signs in the emergency department (disallowed previously by CMS); and expressed ACEP's support for Prescription Drug Monitoring Programs (PDMPs), although he recommended the data by pushed to, rather than pulled by, healthcare providers.
    Senate Committee Conducts Another Hearing on Mental Health Issues
    The U.S. Senate Health, Education, Labor & Pension (HELP) Committee met on Wednesday morning to conduct a hearing entitled “Improving the Federal Response to Challenges in Mental Health Care in America.” Witnesses included several healthcare providers and a former patient turned educator. Committee chairman Sen. Lamar Alexander’s (R-TN) opening remarks highlighted the stark situation of mental health in the U.S. today. According to a 2014 SAMHSA survey about 1 in 5 adults had a mental health condition in the past year, and 9.8 million adults had serious mental illness. However, nearly 60%of adults with mental illness did not receive mental health services in 2014. The committee's ranking Democrat, Sen. Patty Murray (D-WA), highlighted several particular challenges, including the need to increase access to psychiatry services with and from the emergency department.

     Some of the major themes during the testimony and subsequent discussion included increasing access to mental health services from both the community and emergency department, promoting early-intervention programs, continuing work to de-stigmatize mental illness, increasing the availability of beds in both inpatient and outpatient psychiatric facilities, and the need for additional research into the connection between psychiatric and physical illnesses. The importance of improving access to mental health medical records and conveying critical diagnoses and treatment options to caregivers in emergency situations was also discussed. However, Chairman Alexander expressed concerns about how the committee could go about modifying HIPAA without raising patient privacy concerns.

    The next steps for the committee would be to debate additional legislative proposals regarding mental health, such as the ACEP-supported bill sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT), the "Mental Health Reform Act of 2015" (S. 1945).

    Jason Bowman, ACEP/EMRA Medical Student Intern, on Capitol Hill

    Regulatory Arena in 2016
    This week, ACEP staff, consultants and representatives of the Emergency Medicine Action Fund (EMAF) met to discuss the regulatory environment in 2016 and strategies to monitor and influence the impact on the practice of emergency medicine. A summary follows:

    • The Obama Administration will continue to push ahead with any lingering regulations to support ACA enrollment, including Medicaid expansion in more states. Often, new Administrations impose moratoria on newly implemented regulations so they have time to review and possibly revise them.
    • Implementation of MACRA, the bipartisan law passed in March 2015 replacing the Sustainable Growth Rate, will be a high priority as it has several important deadlines. ACEP responded to CMS’ “request for information” about MACRA in November and the draft regulation is expected out in the Spring.
    • Implementation of the Merit-based Incentive Payment System (MIPS) which expands the PQRS and includes new bonus/penalty provisions beginning in 2019 based on 2017 physician data measuring quality, resource use, clinical practice improvement activities, and meaningful use*. ACEP is working on new measures.
    • Alternative Payment Models (APMs) – ACEP has convened a Task Force to study and draft models with outside consulting assistance that can be shared with CMS in the next year. The Task Force will have it second in person meeting January 29th in Dallas.

    *CMS leadership has strongly committed to revising “Meaningful Use” requirements (which don’t apply directly to emergency physicians but affect ED Practice). CMS will also lean on EHR vendors to remove barriers to interoperability (which is crucial to the success of APMs).

    Registration Now Open for the 2016 Leadership and Advocacy Conference
    The 2016 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The conference includes special training for first-timers and a deeper dive for seasoned participants to help build upon your already-valuable Congressional connections.

    We’ve brought in the Nation’s experts to lead our discussions. Monday's luncheon will feature political analyst Charlie Cook, Editor and Publisher of the Cook Political Report and Columnist for the National Journal.

    When Charlie Cook makes a pronouncement based on his analysis of the political scene in America, people who want to be “in the know” sit up and listen. For more than two decades he has been Washington’s most trusted – and most accurate – voice on all things political, whether it’s the outcome of a Congressional, gubernatorial, or presidential election.

    For more information or to register, please go to: http://www.acep.org/lac/.

  • Weekly Update, January 15, 2016

    Congressional Schedule
    The Senate will be in recess until Tuesday, January 19 and the House will be out until Monday, January 25. 

    House Bill on DEA Standing Orders Introduced
    Pending federal regulations threaten a longstanding practice that has allowed Emergency Medical Services (EMS) personnel to administer controlled substances to patients who are suffering from severe pain or experiencing seizures, for example. This practice will soon be prohibited unless the nation's Controlled Substances Act is amended accordingly. To address this problem, Rep. Richard Hudson (R-NC), along with six original co-sponsors including Reps. Raul Ruiz (R-CA), Joe Heck (R-NV), G.K. Butterfield (D-NC), Steve Cohen (D-TN), Blake Farenthold (R-TX) and Bruce Westerman (R-AR,) introduced bipartisan legislation, “Protecting Patient Access to Emergency Medications Act” (H.R.4365). The legislation will allow EMS agencies to continue using standing orders from their medical director to administer approved medications to their patients under the Drug Enforcement Administration (DEA).

    The legislation is strongly supported by ACEP and five other national organizations representing Emergency Medical Services (EMS): the American Ambulance Association, Association of Air Medical Services, the Association of Critical Care Transport, International Association of Fire Chiefs (IAFC), the International Association of Fire Fighters (IAFF), National Association of EMS Physicians, National Association of Emergency Medical Technicians and the National Association of State EMS Officials. Click here to see ACEP's Press Release


    ACEP President Dr. Jay Kaplan with Congressman Richard Hudson, sponsor of H.R. 4365.

    EMTALA Liability Bill Reaches 95 House Co-Sponsors 
    Rep. Jackie Walorski (R-IN) recently co-sponsored the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884), one of ACEP’s top legislative priorities. Congressional support for the bill continues to grow.  A complete list of co-sponsors is available here.

    House Committee Advances Criminal Justice/Mental Health Measure
    On Tuesday, the House Judiciary Committee approved by voice vote the "Comprehensive Justice and Mental Health Act (H.R. 1854)," sponsored by Rep. Doug Collins (R-GA). The Senate approved their version of the bill, S. 993, earlier this year. The legislation builds upon the success of the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), which provides federal funds for state and local efforts to provide alternatives to formal criminal justice processing for individuals with mental and behavioral health needs. The bill includes additional support for: 

    • Mental health and veterans treatment courts to address needs related to behavioral or post-traumatic stress disorders;
    • Training on mental and behavioral health in police academies; and
    • Transitional and reentry programs that reduce the risk of recidivism for individuals returning to their communities. 

    Consideration on the House floor has not yet been scheduled.

    Upcoming Senate Mental Health Hearing

    Senate Health, Education, Labor and Pensions (HELP) Committee will hold a hearing titled “Improving the Federal Response to Challenges in Mental Health Care in America" on Wednesday, January 20th. Additional details can be found here.

    Senate Committee Approves Dr. Robert Califf as FDA Commissioner
    President Obama's nominee for commissioner of the Food and Drug Administration won approval from the Senate HELP Committee on Tuesday, but two senators are threatening to block the nominee. Sen. Lisa Murkowski (R-AK) said she will hold up a vote on the Senate floor until she has reassurances from the agency that it will write rules for labeling genetically modified salmon. Presidential contender Sen. Bernie Sanders (I-VT), who is a member of the HELP committee, did not attend the hearing but his office said he would have voted no. Dr. Califf is now the No. 2 official at the agency and was a prominent cardiologist and medical researcher at Duke University for more than 30 years.

    NEMPAC Sponsors Event for House Speaker Paul Ryan 
    On Wednesday, ACEP President Jay Kaplan MD had the opportunity to represent ACEP and discuss the priorities of emergency medicine in 2016 with House Speaker Paul Ryan (R-WI) and his staff during a breakfast event sponsored by NEMPAC and attended by representatives of 20 physician specialty organizations.  Nearly $100,000 was raised for the Speaker’s re-election campaign and leadership efforts. 


    Dr. Jay Kaplan with Speaker Ryan during Wednesday's NEMPAC fundraiser. 

    Registration Open for the 2016 Leadership and Advocacy Conference
    Get ready to join your ACEP colleagues from May 15-18 in Washington D.C. to advocate for the specialty! Click here to register or for more details.

    Regulatory Update
    Final Rule Highlights: Medicare Physician Fee Schedule for 2016

    Payment update for the calendar year 2016 is .05% which was determined by MACRA law making the conversion factor $35.82.

    CMS has included two new time-based codes this year for Advance Care Planning - CPT codes 99497 and 99498.  Codes can be used in facility and non-facility settings and CMS has not imposed restrictions on which physician specialties can use them; ACEP advocated for unrestricted use.  However, these codes are subject to local coverage decisions, which means that your Medicare contractor (MAC) could impose restrictions by region.

    In response to calls for clarification about the confusing language with exclusion of “appropriate use” (imaging) criteria in the ED, CMS will review ACEP's concerns and address the language of next year’s fee schedule rule since appropriate use criteria will not be implemented until 2017.

  • Weekly Update, January 8, 2016

    Congressional Schedule
    The House of Representatives reconvened this week after the holiday recess period. The Senate will return to business next week.

    Executive Actions
    President Obama has asked Congress to allocate $500 million for mental health reform while announcing he would take executive action on existing gun laws and gun sales. Lawmakers in both parties have already introduced mental health legislation this Congress and the president's requests face significant GOP backlash. We expect additional details on the actions in President Obama's last State of the Union Address on Tuesday.

    More on Mental Health
    Sens. Debbie Stabenow (D-MI) and Roy Blunt (R-MO) are expected to introduce legislation expanding the Excellence in Mental Health Act, which they championed in 2014. The law (which was part of the MACRA/SGR bill) currently provides 24 states with preparation grants to create a proposal that could be developed into a payment demonstration program - but the law only provides funding for eight states to launch a demo. The new legislation will expand demonstration program funding to all 24 states.

    First Congressional Activity of 2016
    For the first time since the Affordable Care Act (ACA) was enacted, Congress passed a bill that would repeal most of the healthcare law. On Wednesday, the House approved the Senate-amended version of the budget reconciliation bill by a vote of 240-181. The bill caps off years of debate in the Republican party over the best approach to fighting the healthcare law and would repeal major provisions of the Affordable Care Act (such as the Medicaid expansion, Exchange subsidies, medical device tax and the "Cadillac" tax, among other things) and temporarily defund Planned Parenthood for one year (transferring that money to other women's health programs). The repeal vote was accomplished through the reconciliation process (which can only be used once per year) that allowed the bill to pass in the Senate with a simple majority and avoid a filibuster by Senate Democrats.

    While this is a political victory for congressional Republicans, it will not, ultimately, be a legislative victory as President Obama officially vetoed the bill this morning. Republican leaders in Congress have said they will try to override the veto, but it is likely that neither the House nor Senate has enough votes to successfully do so at this time.

    The bill in its current form would now decrease the federal deficit by more than $550 billion between 2016-2025, should it become law. This change in projected net savings is due to passage of the "taxibus" legislation last month, which delayed certain tax provisions of the ACA law.

    Meanwhile, House Speaker Paul Ryan (R-WI) has asked committee chairs to use several House proposals to replace the ACA with a single plan. Rep. Tom Price (R-GA), a physician and chair of the House Budget Committee, said that Republicans will be merging more than 100 healthcare bills. ACEP will continue to work with lawmakers on these proposals to ensure emergency medicine issues are considered.

    Senate HELP Hearings
    The Senate Health, Education, Labor and Pensions Committee will vote on Robert Califf's nomination to lead Federal Drug Administration (FDA) on Jan. 12 during an executive session. Califf’s confirmation hearing earlier in November was relatively non-controversial and he received endorsements by both Chairman Lamar Alexander and ranking member Patty Murray.

    CMS Demo Project
    Medicare and Medicaid will pay providers and other organizations to screen patients about social needs like homelessness, domestic violence and hunger when they visit the hospital, under a new demonstration project announced Tuesday. The five-year, $157 million project, funded by the Affordable Care Act's Centers for Medicare and Medicaid Innovation, aims at underlying social issues that can exacerbate health needs or lead to preventable hospitalizations. CMS is betting that linking high-cost beneficiaries to social services can both improve their health outcomes and also cut costs.

    The project, dubbed the Accountable Health Communities model, will fund screenings and referrals at more than 40 health systems. At some sites, the project will fund navigators who will help beneficiaries find or apply for participating shelters, food pantries or other social services, and follow up with them until needs are met. At other sites, an overarching organization will also work to identify which social services the community lacks, proposing solutions for a housing shortage, for example. And for a third set of sites, the project will simply screen the patients and refer them to relevant social services.

    2015 in Retrospect
    The 114th Congress enacted 113 laws in 2015. The tally was the highest in the first year of a two-year congressional term since Democrats controlled the House, Senate and the White House. That Congress enacted 125 laws in 2009. The final count for 2015 was significantly higher than either that of 2013 or 2011, the first years of sessions when Congress was split between a Republican House and a Democratic Senate. Ultimately 2015 was far more productive than originally expected especially with a year dominated by the ouster of a House speaker by conservatives of his own party. (Congressional Quarterly)

    Registration Open for the 2016 Leadership and Advocacy Conference
    Get ready to join your ACEP colleagues from May 15-18 in Washington D.C. to advocate for the specialty! Click here to register or for more details.

  • Weekly Update, December 18, 2015

    Congressional Schedule
    Members of Congress headed home today for the two-week Holiday recess period and will return the first week of January. The Weekly Update will provide a preview of the congressional agenda in 2016 in our next issue before Congress reconvenes.

    Congress Approves Major Tax and Spending Bills
    After several weeks of contentious negotiations, the U.S. House and Senate approved major tax and spending bills this week before adjourning for two weeks. The House had to hold separate votes on the two measures because many Democrats opposed the tax-extenders package and many Republicans opposed the omnibus appropriations measure.

    The House approved the tax-extender bill on Thursday by a vote of 318 to 109 (241 Republicans and 77 Democrats voting in favor of the bill). The only Republicans to vote against the bill were: Reps. Justin Amash (R-MI), Chris Collins (R-NY) and Walter Jones (R-NC). On Friday morning, the House approved the omnibus appropriations bill by a vote of 316 to 113 (150 Republicans and 166 Democrats voting in favor of the bill).

    By splitting the votes, House leadership was able to secure majority support for each bill and then allow the Senate to combine the legislation into one, massive bill (colloquially being referred to in Washington as the "taxibus") before sending it to the president for his signature. The Senate approved the taxibus by a vote of 65 to 33.

    The tax-extender bill, which cost $650 billion and was not off-set, included several important health care provisions, such as a two-year reprieve on the medical device tax; a two-year delay for the excise tax on high-cost employer-sponsored health coverage (a.k.a. the "Cadillac tax); and a one-year suspension of the health insurance tax.

    The omnibus appropriations bill contains $1.1 trillion to fund all federal agencies and programs for the remainder of fiscal year 2016 (through September 30, 2016). In addition to the specific funding levels listed below, the omnibus bill:

    • Renews the James Zadroga 9/11 Health and Compensation Act, which ensures first responders get treatment for 9/11-related health problems, for 75 years;
    • Provides $4.6 billion and a five-year extension for a related victim compensation fund;
    • Limits funding of the risk corridor program for insurers with excess losses;
    • Effectively defunds the Independent Payment Advisory Board (IPAB) for 2016 [Note: Medicare spending has not yet reached level to trigger cuts, but the ACA gives the Secretary of HHS the authority to take action on behalf of IPAB if it cannot make recommendations];
    • Provides full funding for state Assisted Outpatient Treatment (AOT) programs that give courts the ability to mandate treatment for individuals with a serious mental illness and a history of arrest, repeat hospitalizations or violence because of their condition; and
    • Provides $15 million to fund the "Mental Health First Aid Act," which trains emergency services personnel, police officers, educators, primary care professionals, students, and others to recognize mental illness and substance abuse disorders, de-escalate crisis situations safely and initiate timely referral to the appropriate resources.

    Specifically, the omnibus bill provides funding at the following levels for key programs:
    ($ In Thousands)

     

    FY 2015

    FY 2016

    Difference

    National Institutes of Health (NIH)

    $30,084,000

    $32,084,000

    $2,000,000

    National Institute of General Medical Services

    $1,656,476

    $1,732,073

    $75,597

    National Institute on Drug Abuse

    $1,028,614

    $1,077,488

    $48,874

    National Institute on Mental Health

    $1,463,036

    $1,548,390

    $85,354

     

     

     

     

    Centers for Disease Control & Prevention (CDC)

    $6,925,776

    $7,233,403

    $307,627

    Prescription Drug Abuse

    $20,000

    $70,000

    $50,000

    Injury Prevention & Control

    $170,447

    $236,059

    $65,612

     

     

     

     

    National Health Service Corps

    $0

    $0

    $0

    Mental & Behavioral Health

    $8,916

    $9,916

    $1,000

    Children's Hospital GME

    $265,000

    $295,000

    $30,000

    Traumatic Brain Injury (TBI)

    $9,321

    $9,321

    $0

    Emergency Medical Services for Children (EMSC)

    $20,162

    $20,162

    $0

    Poison Control Centers (PCCs)

    $18,846

    $18,846

    $0

    Rural & Community Access to Emergency Devices

    $4,500

    $0

    ($4,500)

    Telehealth

    $14,900

    $17,000

    $2,100

     

     

     

     

    Substance Abuse & Mental Health Services Administration (SAMHSA)

    $3,619,712

    $3,779,936

    $160,224

    Substance Abuse

    $2,183,858

    $2,195,424

    $11,566

    Mental Health

    $1,078,975

    $1,166,987

    $88,012

     

     

     

     

    Victims of Trafficking

    $15,755

    $18,755

    $3,000

    Elder Falls Prevention

    $0

    $0

    $0

     

     

     

     

    HHS Assistant Secretary of Preparedness & Response (ASPR)

    $1,045,580

    $1,396,628

    $351,048

    Preparedness & Emergency Operations

    $24,789

    $24,654

    ($135)

    National Disaster Medical System

    $50,054

    $49,904

    ($150)

    Hospital Preparedness Cooperative Agreement Grants

    $254,555

    $254,555

    $0

     

     

     

     

    Pandemic Influenza Preparedness

    $71,915

    $72,000

    $85

    ACA Exchange Enrollment Deadline Extended
    Tuesday was supposed to be the final day that individuals could enroll through the federally facilitated marketplace, which serves 38 states and Covered California, for coverage effective January 1, 2016. Because interest in the program has overwhelmed capacity of the marketplace to process applications, the deadline was extended to 11:59 p.m. (PST) on Thursday. Several state marketplaces have also extended the deadline for coverage on January 1. Any individual who does not have health insurance by the January 31 open enrollment deadline will owe at least $695 when filing his/her taxes for that year.

  • Weekly Update, December 11, 2015

    Congressional Schedule

    Omnibus Riders, Tax Extenders, and Then Go Home?
    Negotiations continued this week over an omnibus year-end spending bill that will allocate nearly $66 billion in additional spending to federal programs. A temporary funding bill expired today but House Appropriations Committee Chairman Hal Rogers (R-KY) introduced a continuing resolution on Wednesday that would give Congress until midnight on Dec. 16 to pass an omnibus spending bill.

    At this writing, dozens of issues remain unresolved, mainly policy disputes over environmental and other issues that lawmakers of both parties are trying to attach to the must-pass spending legislation. Republicans are seeking to lift the oil export ban and roll back various Obama administration regulations; Democrats are maneuvering to protect President Barack Obama's environmental rules and enact permanent tax credits for wind, solar and other renewable energy. Senate Majority Leader Mitch McConnell (R-Ky.) is also pushing a rider to eliminate limits on coordinated party spending.

    Many Democrats are vowing to vote against any spending bill that does not end a ban on gun violence research by the Centers for Disease Control and Prevention. ACEP will be joining a host of medical and public health organizations representing health professionals across the country in signing a letter calling on Congress to end the ban on federal gun violence research. The letter is currently in draft form but will be available next week.

    Outside of the omnibus, the other remaining big question is what happens to a series of expiring tax provisions known as extenders. A deal to make some Republican and Democratic priorities permanent, instead of reauthorizing them on the typical two-year basis, is in the works, but by no means a certainty. A major concern about the potential deal is the cost, which has been variously reported in the $700 or $800 billion range.

    Several health care provisions could be included in the tax extenders package including a potential repeal (or more likely a two year delay) of the Affordable Care Act’s “Cadillac tax” and its medical device tax. There is substantial support among Democrats and Republicans to repeal both taxes, although the cost of doing so is prohibitive.

    A reauthorization of the Zadroga Act, an expiring health fund for first responders to the Sept. 11 terror attack, which carries an $8 to 11 billion price tag over the next decade, could be included in the tax package, although that provision could also be part of the omnibus spending bill.

    Other Congressional Actions

    Opioid Abuse Hearing
    On Tuesday, the Senate HELP committee held a full committee hearing to address the growing epidemic of opioid drug abuse and overdose. Some of the main issues discussed in the hearing pertained to naloxone, fentanyl, medically assisted treatment for drug abuse, the nexus between mental health and substance abuse, early education on opioids, strengthening the prescription drug monitoring program (PDMP) and instituting changes within the DEA to improve surveillance of doctor shopping. Leana Wen, MD, the Baltimore City Health Commissioner and an emergency physician, testified and shared some ways the city of Baltimore is attempting to address the national crisis of opioid abuse. To view the hearing and learn more, please click here. 

    In addition, this morning the CDC announced that it will post draft guidelines on opioid prescribing methods and open them up for a 30 day comment period. ACEP continues to work in conjunction with other medical specialties as part of the AMA Working Group to combat opioid abuse.

    White House Plans Forums on Opioid Epidemic
    The White House's National Drug Control Policy Director Michael Botticelli next week will begin holding community forums across the country to discuss best practices and evidenced-based initiatives to prevent and treat prescription drug abuse and heroin use. The first forum will be next Wednesday in Oklahoma. The sessions will include public health and public safety officials as well as people who have been directly affected by the opioid epidemic.

    Senate Approves Mental Health/Criminal Justice Reform Bill
    The Senate late Thursday approved a mental health measure sponsored by Sen. Al Franken (D-WI) that provides crisis intervention training, funding for mental health courts, veterans treatment courts and training for state and federal law enforcement officers. It now heads to the House. Sen. Franken's bill focuses primarily on law enforcement and criminal justice reform unlike more comprehensive mental health bills supported by ACEP (S.1945/H.R.2646), which are awaiting consideration in the Senate HELP and the House Energy and Commerce Committees.

    For more information on these bills, please go to ACEP Advocacy Website/Key Issues

  • Weekly Update, December 4, 2015

    Lawmakers are heading home for the weekend, but the clock continues to wind down on the deadline for an omnibus spending agreement to fund government agencies and programs through the remainder of fiscal year 2016. With one week left before federal spending authority expires, it remains unclear whether Congress will choose another short-term extension or a comprehensive funding package. Congress is tentatively scheduled to go into recess for the remainder of the year next week, but with several major issues outstanding (including the omnibus appropriations bill), it appears increasingly likely that they will need to return for at least several days the following week to wrap-up business.

    Senate Reconciliation Vote to Repeal ACA
    Late last night, the Senate passed legislation repealing some of the core pillars of the Affordable Care Act (aka Obama Care), taking a major step toward sending such a bill to the president’s desk for the first time. The measure passed 52 to 47, largely along party lines with a few exceptions – Sens. Mark Kirk (R-IL) and Susan Collins (R-ME) voted “no” and Sen. Bernie Sanders (I-VT) was not present for the vote.

    The Senate reconciliation bill modified the House-approved proposal by including a phase-out of state Medicaid expansions encouraged by the ACA and adopted by 30 states. The Senate bill also repeals the over-the-counter medicine tax, the prescription drug tax, an annual fee on health insurers and the tax on indoor tanning services. It reduces the threshold of healthcare costs that can be deducted from 10 percent to 7.5 percent of adjusted gross income. It cuts funding for the Prevention and Public Health Fund and eliminates risk adjustment programs from insurance companies that lose money because of the law. The House version of the bill eliminates the individual and employer mandates, the Cadillac tax on expensive insurance plans and the medical device tax.

    The House approved its version of the reconciliation bill (H.R. 3762) on Oct. 23 by a vote of 240 to 189, but it must now pass the amended Senate bill before it can be sent to the president. President Obama has stated he will veto the measure and congressional Republicans do not have enough votes to override the veto.

    While the reconciliation bill will not become law, this marks the first time the Senate has allowed a standalone vote on repealing the ACA.

    Transportation Bill Approved
    Also yesterday, Congress approved a five-year, $305 billion transportation bill (H.R. 22) to fund road, rail and infrastructure projects. This represents the longest time frame for a transportation bill in the past 17 years. Under this bill, ferries would receive money and seven northeastern states would get to keep their $1.3 billion funding pool for mass-transit systems. Auto companies would face higher fines for safety defects and Wisconsin logging trucks could return to roads currently declared off-limits.

    The legislation also includes an ACEP-supported provision to require the National Highway Traffic Safety Administration (NHTSA) to integrate active safety technology into their current (5-Star rating) crashworthiness system. ACEP has been working with Rep. Todd Rokita (R-IN) to enact this provision for several years.

    The Senate approved the measure 83 to 16 after a 359 to 65 vote in the House earlier in the day. President Obama is expected to sign H.R. 22 into law.

    Appropriations Update
    Negotiations continued this week between Republicans and Democrats on the $1.1 trillion FY 16 omnibus appropriations bill. With the increase in defense and non-defense funding agreed to a couple of weeks ago, the primary obstacle in reaching a deal surrounds the issue of policy riders on issues such as immigration, foreign policy, the environment, etc. It is not uncommon for policy provisions to be attached to appropriations measures since these are must-pass bills. However, Democrats so far have been united in their opposition to the inclusion of ANY policy riders. With enough support from their conference, House Republicans could pass the bill without any Democratic votes. However, such a strategy would likely encounter problems in the Senate where 60 votes are often needed to advance legislation.

    The current short-term funding of the federal government expires Dec. 11. Congress must either enact another short-term “Continuing Resolution” (CR) to give them more time to negotiate or reach an agreement on the comprehensive funding package before the deadline if they want to avoid a government shutdown.

    DEA-EMS Standing Orders
    Earlier this week, ACEP, working in conjunction with NAEMSP, NAEMST and others, finalized draft legislation and submitted it to Rep. Richard Hudson (R-NC) for his consideration and introduction. The primary goal of this legislation would be to pre-empt any attempt by DEA to disallow the use of standing orders by EMS medical directors when EMS personnel deliver or administer controlled substances. Rep. Hudson is currently sharing his bill language with other key Members of Congress and committee staff with the intent to introduce this bill before the end of the year.

    VA Staffing Legislation – House Companion Bill Introduced
    On Tuesday, Reps. Raul Ruiz (D-CA) and Brad Wenstrup (R-OH) introduced the House companion bill, H.R. 4150, to Sen. Mazie Hirono’s (D-HI) "Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act" (S. 1450). This legislation would provide the Veterans Health Administration (VHA) with more flexibility to recruit and retain physicians who maintain 24-hour coverage, such as emergency physicians and hospitalists. Currently, these full-time VHA employees must work 80 hours every two weeks. S. 1450/H.R. 4150 would allow these physicians to work more or less than the required 80 hours to provide accommodations for their irregular schedules. To view ACEP’s letter of support, click here.

    EMTALA Liability Bill Garners More Support in the House
    One of ACEP's top legislative priorities, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884), continues to garner congressional support. Since last reported, additional Members of Congress have been added to the House bill, including Reps. John Fleming (R-LA), Curt Clawson (R-FL), Tom Reed (R-NY), Patrick McHenry (R-NC) and Brad Wenstrup (R-OH). H.R. 836 now has a total of 94 bi-partisan co-sponsors and S. 884, has six co-sponsors.

  • Weekly Update, November 20, 2015

    Legislators headed home for Thanksgiving recess late this week and will return on Monday, November 30. The clock is ticking toward a Dec. 4 deadline for resolving differences between House and Senate versions of a six-year highway and transit authorization. Also on the agenda are refugee provisions expected to be attached to a final must-pass omnibus spending bill.

    Congress Approves Emergency Psychiatric Legislation
    On Monday evening, the House approved an amended version of S. 599, the "Improving Access to Emergency Psychiatric Care Act," by voice vote and the Senate agreed to the House changes yesterday, clearing the way for the president to sign the bill into law.

    The legislation temporarily extends and expands the ACEP-supported Medicaid Emergency Psychiatric Demonstration program that was established in the Affordable Care Act in 2010. The demonstration program provided $75 million in federal Medicaid matching funds over three years to enable private psychiatric hospitals, known as Institutions for Mental Disease (IMDs), to receive reimbursement for treating adult patients (aged 21 to 64) with psychiatric emergencies (suicidal/homicidal thoughts). Outside of the 11 participating states and the District of Columbia, Medicaid does not pay IMDs for these services without an admission to an acute care hospital first.

    With the enactment of S. 599, the demonstration will be extended through September 2016 or whenever HHS completes its final evaluation of the project, whichever comes first, provided the extension would not increase Medicaid costs. It also allows HHS to extend the program for an additional three years and expand it to other states (subject to the same budget-neutral requirement).

    ACEP has long supported the elimination of the IMD exclusion in Medicaid.

    End-of-Life Planning Legislation Introduced in Congress
    On Wednesday, Sens. Chris Coons (D-DE) and Bill Cassidy (R-LA) and Reps. Diane Black (R-TN), Mike Thompson (D-CA), Chris Collins (R-NY) and Peter Welch (D-VT) introduced legislation, the "Medicare Choices Empowerment and Protection Act," to encourage Medicare beneficiaries to voluntarily create electronic advance directives by providing a one-time financial incentive ($75 rebate from Part B premium) for seniors who establish and register their certified and secure directive online. The ACEP-supported program would provide beneficiaries with access to a website with model advance directives representing a range of options. The directives would be created through, and maintained by outside organizations certified by CMS and could be modified or terminated at any time by the beneficiary.

    Click here to read ACEP's letters of support to Sen. Coons or Rep. Black. Click here to read Sen. Coons' one-page summary of the legislation.

    Ways and Means Committee Changes
    The new chairman of the House Ways and Means Committee, Rep. Kevin Brady (R-TX), announced the selection of new subcommittee chairs and subcommittee assignments for Republican Members of the committee. The new assignments were necessitated by the election of former committee chairman Paul Ryan as Speaker of the House, Brady’s selection to follow him as committee chair, and the selection of Congressman Tom Rice (R-SC) to fill the vacancy on the committee. Rep. Pat Tiberi (R-OH) was named chairman of the Health Subcommittee.

    CMS Solicits Input on Implementing MACRA
    ACEP responded to CMS’ Request for Information about Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS) this week. MACRA, the SGR replacement law, requires physicians to make significant changes in quality measurement and reporting, and encourages them to create new ways of organizing and providing care that will not be paid for using fee-for-service. This request is a precursor to a draft regulation which will be released later this year. The letter outlines our many concerns with CMS’ current models and measures, as well as stating our principles for creation of new physician-focused models that would make sense for hospital-based physicians who do not fit neatly into the current medical home construct.

    ACEP Advocacy on Facebook/Twitter
    Have you checked our ACEP Advocacy Facebook page or Twitter lately? Don’t forget to like our site. See ACEP members in action hosting ED visits for legislators and testifying before Congress.

  • Weekly Update, November 6, 2015

    Next week, the Senate will kick off debate on the FY16 Military Construction-VA spending bill, their first fiscal 2016 appropriations bill to come to the floor this year.  The House will be out next week and will return Monday, Nov. 16, following a one-week Veterans Day recess.

    House Committee Approves Mental Health Bill  

    On Wednesday, the House Energy and Commerce Health Subcommittee approved the ACEP-supported "Helping Families in Mental Health Crisis Act of 2015" (H.R. 2646) by a vote of 18 to 12. The bill was backed by all Republicans and one Democrat, Rep. Kurt Schrader (D-OR).  

    During the day-long mark-up, members of the subcommittee from both parties offered amendments to the underlying proposal. Some of the most controversial provisions were related to the Substance Abuse and Mental Health Services Administration (SAMHSA), HIPAA privacy laws and Assisted Outpatient Treatment (AOT) programs. Nearly all of the amendments were rejected (mostly along party-line votes) during the subcommittee mark-up. However, the bill's sponsor, Rep. Tim Murphy (R-PA), and the full committee chairman, Rep. Fred Upton (R-MI), made commitments to work with these members on their suggested changes as the bill moves to the next step, which will be consideration by the full committee. No date has been set yet as to when the full committee will mark-up the bill.  

    As changes to this important legislation are considered throughout the legislative process, ACEP will continue to examine these proposals and how they may impact the legislation's ability to provide resources and help to individuals with serious mental illness and their families.

    Synthetic Drug Bill Advances  
    Also on Wednesday, before the House Energy and Commerce Committee considered the mental health reform bill, members approved H.R. 3537, the "Synthetic Drug Control Act of 2015," by voice vote. This ACEP-supported legislation would add more than 200 known synthetic drugs that have been identified by the DEA to Schedule I of the Controlled Substances Act and facilitate federal prosecution of the manufacturers, distributors and sellers of synthetic drugs.

    Reconciliation Bill Still in Search of 51 Votes  
    Senate Republicans are running various options by Parliamentarian Elizabeth MacDonough to see how much more of the 2010 health care law they could repeal through budget reconciliation without running afoul of Senate rules. GOP leaders are engaged in the delicate task of determining how to amend the House-passed legislation to make it acceptable to at least 51 of the 54 Republicans in the Senate. As previously reported in the Weekly Update, the House voted 240-189 on the bill, with one Democrat, Rep. Colin Peterson (D-MN), voting in favor. The bill would repeal some key parts of the president’s healthcare law, including the individual and employer mandates, the so-called “Cadillac” tax as well as the medical device tax. It would also halt funding to Planned Parenthood for one year. 

    House Ways and Means Committee Changes  
    Rep. Kevin Brady (R-TX) won a hotly contested race on Wednesday to be the next chairman of the powerful House Ways and Means Committee, succeeding former chairman Paul Ryan (R-WI), who relinquished the seat when he was elevated to Speaker of the House. Yesterday, the full Republican conference agreed with the Steering Committee's recommendation and approved his selection by voice vote.  

    With Brady's ascension to chairman of the full committee, a new chairman of the Health Subcommittee will need to be chosen. There is talk that the other contender for the top committee post, Rep. Pat Tiberi (R-OH), may leave his position as chairman of the Trade Subcommittee to take the health panel's gavel. Other names in the mix include Reps. Charles Boustany (R-LA) and Vern Buchanan (R-FL).  

    Rep. Tom Rice (R-SC) was selected to take the Ways and Means Committee slot vacated by Ryan.

    Other News  
    On Friday, House Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-PA) announced he will retire at the conclusion of the 114th Congress. Chairman Pitts was first elected to Congress in 1996 and is serving in his 10th term.

    Triple E Campaign Winners
    In Boston, during the ACEP Council meeting, the Arizona, Michigan, North Carolina and Texas ACEP Chapters were recognized for their outstanding efforts in the 911 Network “Triple E Campaign.” EMRA also received an award for going the extra mile in engaging EM residents in legislative and political advocacy.

    2015 911 Network Member of the Year
    Dr. Arlo Weltge from Houston, TX was recognized at the ACEP Council Meeting in Boston as the 911 Network Member of the Year.

    Please go to ACEP Advocacy Website for more information on these ACEP Advocacy Stars!

  • Weekly Update, November 2, 2015

    Rep. Paul Ryan (R-WI) will begin his first week as the newly elected Speaker of the House (see story below). The House is expected to tackle a highway and transit funding bill this week as the current funding stopgap expires Nov. 20. The Senate will take up a bill on the Waters of the United States rule. The president is expected to sign the two-year budget deal into law today. 

    New Speaker of the House Elected
    The House elected Rep. Paul Ryan (R-WI) as the chamber’s 62nd Speaker last Thursday. Republicans provided 236 votes (218 needed) to make the 45-year-old the youngest speaker since the civil war era. Nine Republicans voted for Rep. Daniel Webster (R-FL) and California Democrat Nancy Pelosi received 184 votes from her caucus (three Democrats voted for another candidate). Rep. Ryan, the Republican Party's 2012 vice presidential nominee has promised to govern the House more inclusively.

    In closed-door meetings with House colleagues, Mr. Ryan has said he wants to overhaul the tax code, replace President Barack Obama's health law, and rewrite federal poverty programs. He intends to use the legislative process to draw a contrast with Democrats heading into the 2016 presidential election. The House Freedom Caucus, a group of almost 40 hard-line conservatives, wants Mr. Ryan to turn more power over to the rank-and-file, a shift they see him endorsing. The caucus also stated that Mr. Ryan also promised to only bring bills to the floor that have the support of a majority of the majority (at least 124 of the 247 Republicans).

    Congress Approves Two-Year Budget Deal
    During the past several weeks, Congress and the White House worked to finalize a deal that would increase the national debt limit and government spending for the next two fiscal years. The deal averted a potential default on government obligations that was scheduled to occur this week had Congress not intervened.  The legislation, the "Bipartisan Budget Act of 2015" (H.R. 1314), extends the debt ceiling through March 2017 and increases discretionary spending caps (set by the 2011 sequestration agreement) by a total of $112 billion. The additional discretionary money includes $80 billion ($50 billion in FY 2016 and $30 billion in FY 2017) split evenly between defense and non-defense programs, as well as an extra $32 billion for defense provided through the Overseas Contingency Operations account.

    To offset these costs, negotiators tapped a number of sources, including making changes to Medicare and Social Security, auctioning off government controlled wireless spectrum, selling crude oil from the Strategic Petroleum Reserve, and tightening tax rules for business partnerships, among other things. The legislation will also limit a historic premium increase for some Medicare Part B beneficiaries, which is set to go into effect next year. Under the deal, Medicare Part B beneficiaries facing premium increases would pay less than anticipated (14% more next year instead of 52%), as well as face a smaller increase in the deductible. To help offset this additional cost, there will be a $3 per month premium surcharge over the next five years.

    Other pay-fors of note include a one-year extension of the sequester's 2% Medicare physician reimbursement cut and implementation of site-neutral payments for new provider-based hospital outpatient departments. Beginning in 2017, these practices will no longer be eligible to bill under the Hospital Outpatient Prospective Payment System, rather they will be reimbursed either through the Ambulatory Surgical Center or physician payment systems.

    The House approved the legislation on Wednesday by a vote of 266 to 167 and the Senate approved it early Friday morning by a vote of 64 to 35. The president is expected to sign the bill into law within the next couple of days.

    Once this legislation is signed into law, the House and Senate appropriations committees will begin the process of writing an omnibus bill that will determine how the funds will be spent. That process is expected to take about a month and could be complicated if there is an effort to attach controversial policy provisions, such as defunding Planned Parenthood. Democrats have vowed to block any "poison pill" riders, which could create another spending standoff in December.

    House Committee Considers Mental Health and Synthetic Drug Bills
    On Wednesday, the House Energy and Commerce Health Subcommittee will mark-up two ACEP-supported bills – H.R. 2646, the "Helping Families in Mental Health Crisis Act," and H.R. 3537, the "Synthetic Drug Control Act of 2015."  H.R. 2646 represents the most comprehensive effort in Congress to improve the nation’s inadequate mental health services and the bill currently has 156 bi-partisan co-sponsors. However, nearly 20 House Democrats sent a letter recently to the chairman and ranking member of the full Energy and Commerce committee expressing their concerns with several of the bill’s provisions, including how it deals with the Assisted Outpatient Treatment (AOT) program, HIPAA and the Substance Abuse and Mental Health Services Administration (SAHMSA).

    Meanwhile, the Senate HELP Committee held a hearing last Thursday entitled "Mental Health and Substance Use Disorders in America: Priorities, Challenges, and Opportunities." This hearing helped promote the need for mental health reform legislation, such as the ACEP-supported bill sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT), the "Mental Health Reform Act of 2015" (S. 1945).  Sens. Cassidy and Murphy expect their legislation to be considered by the committee early next year, if not sooner.

    We expect the synthetic drug bill to be far less controversial. During the last several weeks, ACEP has participated in the press conference announcing the introduction of the bill and testified as a witness before this subcommittee urging Congress to curb access to these dangerous synthetic drugs.

    New Leadership for House Ways and Means Committee
    With the election of Paul Ryan as Speaker of the House, his position as Chairman of the Ways and Means Committee was vacated. On Wednesday, the Republican Steering Committee will meet to select the next Chairman and the contest is between Reps. Kevin Brady (R-TX), the more senior member and Chairman of the Health Subcommittee, and Pat Tiberi (R-OH), Chairman of the Trade Subcommittee.

    EMTALA Liability Bill Garners More Support in the House
    One of ACEP's top legislative priorities, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) continues to garner congressional support. Since last reported, additional Members of Congress have been added to the House bill bringing the overall total co-sponsorship in the House to 89 and six in the Senate. The most recent additions include: Reps. Vicky Hartzler (R-MO), Devin Nunes (R-CA) and Rob Woodall (R-GA).

    ACEP Advocacy in High Gear at ACEP15 in Boston
    Emergency physicians attending ACEP15 in Boston last week had many opportunities to learn about and support ACEP's advocacy agenda in preparation for a packed legislative agenda in Congress and the 2016 elections.   As in years past, ACEP council members stepped up to the plate during the NEMPAC Council challenge to ensure that emergency medicine stays at the top of the leader board among medical PACs and continues to be a strong, respected voice in Washington DC.  

    Prior to and during the ACEP Council meeting over the weekend, NEMPAC collected nearly $300,000 from council members. Combined with thousands of donations by ACEP members across the country this year, NEMPAC is well on the way to exceeding the $1 million goal set by the ACEP Board in 2015. 

    NEMPAC’s growth has allowed ACEP to be involved in hundreds of races across the country and help the re-election efforts of two ACEP members:  Dr. JoeHeck (R-NV), who is running for Senate in Nevada and Dr.Raul Ruiz (D-CA). During ACEP15 in Boston, NEMPAC and the USACS PAC co-hosted fundraising events for both legislators, raising thousands of dollars from ACEP members at the conference for the respective campaigns.

    For more information or to make a contribution to NEMPAC, please go to the NEMPAC website and log-in with your ACEP credentials.

    Results of the Triple E Campaign
    During the ACEP Council meeting, the Arizona, Michigan, North Carolina and Texas ACEP Chapters were recognized for their outstanding efforts in the 911 Network “Triple E Campaign.” EMRA also received an award for going the extra mile in engaging EM residents in legislative and political advocacy.

    Dr. Arlo Weltge from Houston, TX was recognized as the 911 Network Member of the Year

    For more information, please go to www.acepadvocacy.org

  • Weekly Update, October 23, 2015

    ACEP Hosts Mental Health Teleforum
    Earlier this week ACEP 911 Network members had a unique opportunity to hear live from Senator Chris Murphy (D-CT) about the status of mental health reform in the 114th Congress. The call was moderated by ACEP President Mike Gerardi, MD, FACEP and several 911 Network members shared their concerns and asked questions about mental health legislations' passage through Congress. The Senator detailed the bi-partisan legislation (S.1945) that he recently introduced with Sen. Bill Cassidy (R-LA) and how they plan to advance the important legislation later this year. 

    Next week the Senate HELP Committee will hold a non-legislative hearing with Administration witnesses to further discuss mental health and substance abuse priorities, challenges and opportunities. To watch the upcoming hearing on Thursday, October 29th, click here.

    Thank you to those who were able to participate in the recent teleforum. Look for future ACEP’s 911 Network teleforums on other hot topics impacting emergency medicine. To join the ACEP 911 Network go to www.acepadvocacy.org 


    ACEP Testifies Before Congress on Synthetic Drugs

    On Tuesday, the House Energy and Commerce Health Subcommittee completed its review and discussion of several bi-partisan bills that would help combat the growing drug abuse crisis. Dr. Kenneth Katz, an emergency physician and toxicologist from Lehigh Valley Health Network (Allentown, PA), testified on behalf of ACEP at the hearing. Dr. Katz's testimony focused on the dangers posed by synthetic drug use; the impact of these drugs on individuals, families and communities around the country; and ACEP's support for H.R. 3537, the "Synthetic Drug Control Act of 2015," sponsored by Reps. Charlie Dent (R-PA) and Jim Himes (D-CT).

    This legislation would add more than 200 known synthetic drugs that have been identified by the DEA to Schedule I of the Controlled Substances Act and facilitate federal prosecution of the manufacturers, distributors and sellers of synthetic drugs.

    To view the hearing, click here.

    House Repeals Part of Obamacare
    On Friday, the House of Representatives voted along party lines to approve a budget reconciliation bill that would repeal parts of ObamaCare and halt federal funding for Planned Parenthood. Only seven House Republicans voted against the partial ObamaCare repeal bill, though it has become a target of opposition from some 2016 presidential candidates as well as influential advocacy groups because it does not repeal the entire health care law. The final total was 240-189, with one Minnesota Democrat, Rep. Colin Peterson, voting in favor. The bill would repeal some key parts of the president’s healthcare law, including the individual and employer mandates, the so-called “Cadillac” tax as well as the medical device tax. It would also halt funding to Planned Parenthood for one year. Provisions on repealing the Independent Payment Advisory Board (IPAB) were ultimately left out of the final House reconciliation bill. The budget reconciliation bill faces an uncertain fate in the Senate, even though it requires only a simple majority of 51 senators to pass it instead of the super-majority of 60 senators usually needed to approve major legislation.

    Balance Billing Ban Legislation Introduced
    On Wednesday, Rep. Lloyd Doggett (D-TX) introduced H.R. 3770, the “End Surprise Billing Act.” The bill would stop balance billing by requiring advanced patient consent before being treated by a hospital, critical access hospital, or providers at those facilities not on their insurance plan. If such consent is not possible—for example because the patient is experiencing a medical emergency—the patient would only pay what they would have paid for the same covered benefits received from a health professional on their insurance plan. Many states have begun to address this issue, but Rep. Doggett’s bill is one of the first introduced this session at the federal level.

    ACEP is reviewing the legislation and we will provide additional details next week.

  • Teleforum Reminder: Wednesday, Oct. 21, 2015

    REMINDER
    “ACEP TELEFORUM” ON MENTAL HEALTH REFORM
     EFFORTS IN CONGRESS

    Wednesday, October 21 at 2:00 PM ET

    ACEP will be hosting a special teleforum to provide more details about efforts in Congress to address mental health reform.  

     Our special guest will be Senator Chris Murphy (D-CT) who will discuss bi-partisan legislation (S.1945) that he recently introduced with Sen. Bill Cassidy (R-LA).  

     Other initiatives in Congress will also be discussed along with ACEP’s advocacy plan on this issue and how you can contact your U.S. Senators and Representative. 

    ACEP President Mike Gerardi, MD, FACEP will moderate the call and ACEP Public Affairs Division staff will provide additional information. You will automatically receive a call at 2:00 pm eastern time on October 21 at the home telephone that we have on record for you in the ACEP database.  Since we are not permitted to contact your cell phone without express permission, we urge you to pre-register for the call here: https://vekeo.com/event/acep-19957/.

    To invite an ACEP colleague to join the call, please encourage them to sign-up for the 911 Network first with their login credentials and then also register at this link: https://vekeo.com/event/acep-19957/

    You will be prompted to stay on the call and will have the opportunity to ask questions during the call. You can also dial in to the call at 877-229-8493 with code 114160.                         
    Mental Health Reform Details
    For years, state support for mental health resources has been on the decline and services for psychiatric patients in the United States are simply inadequate. As a result of this diminishing support, psychiatric patients are more and more often turning to emergency departments for their acute care needs. Unfortunately, it takes three times as long to find an inpatient bed for a psychiatric patient rather than a medical patient after the decision to admit has been made. These psychiatric patients require more physician, nurse and hospital resources than other patients and, thus, diminish our ability to evaluate and treat other medical patients who are awaiting emergency care services.  

    The prevalence of mental illness in this country, combined with a lack of resources to care for these individuals in the most appropriate setting, is a national crisis. Systemic changes are needed in the way individuals with mental illness are cared for in this country.  

    In order to help ensure that resources are made available to conduct vitally-needed research on this issue and to fund additional inpatient and outpatient treatment beds with the corresponding professional staff, ACEP supports H.R. 2646, the "Helping Families in Mental Health Crisis Act of 2015," introduced by Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX), and S. 1945, the "Mental Health Reform Act of 2015," introduced by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT).  

    While there are differences between the two bills, there are also many similar provisions that are of interest to ACEP, including:

    • Creation of an Assistant Secretary for Mental Health and Substance Use Disorders and the National Mental Health Policy Lab,
    • Extension of the Assisted Outpatient Treatment (AOT) grants,
    • Promotion of telemedicine services,  
    • Liability protections for volunteers at Community Health Centers and Community Behavioral Health Centers,
    • Expansion of the mental health workforce,
    • Clarification of HIPAA privacy rules for patients with mental illness and their caregivers,
    • Elimination of the Medicaid same-day and IMD exclusions,
    • Improving credentials for peer review and advisory council members, and
    • Efforts to implement mental health parity in health plans.    

    H.R. 2646 and S. 1945 are not the only mental health bills that have been introduced in the 114th Congress, but these bills represent the most comprehensive efforts to reform a significant number of mental health programs.  Other provisions from bills such as S. 1893, the "Mental Health Awareness and Improvement Act of 2015;" H.R. 1854/S. 993, the "Comprehensive Justice and Mental Health Act of 2015;" and S. 2002, the "Mental Health and Safe Communities Act of 2015" should also be carefully considered when the House and Senate advance their mental health reform proposals.

  • Weekly Update, October 9, 2015

    A House Divided
    The Senate is out of session but the House remained in town this Friday for further discussions on the pending House leadership race and vote to lift the ban on American oil exports.

    The Republican caucus met this morning behind closed doors to discuss a path forward for the speakership and GOP leadership shuffle. The turmoil instigated by front runner Rep. Kevin McCarthy (R-CA) dropping out of the speaker election at the last minute has widened the divide between pro-business Republicans and tea party activists. Rep. Paul Ryan (R-WI) is the favored pick for the next Speaker position but he has thus far declined and has stated that he is comfortable in his spot as Chairman of the influential House Ways and Means committee. Reps. Jason Chaffetz (R-UT) and Daniel Webster (R-FL) are still candidates for speaker. GOP lawmakers continue to talk about a host of other Republicans for the post, including Reps. John Kline (R-MN), Lynn Westmoreland (R-GA), Tom Cole (R-OK) and Darrell Issa (R-CA) among others. In the absence of a clear front-runner, the field of alternatives continues to grow and it is not clear that any of the would be contenders can rally the 218 votes necessary to become the next Speaker of the House.

    It is speculated that Speaker Boehner (R-OH) will stay in his current job until a successor is named, however there continues to be no set date for the leadership election and Speaker Boehner still hopes to resign from Congress at the end of this October.

    Both the House and Senate chambers will be in recess next week, the week of October 12- 16th, for Columbus Day and the Jewish holiday. Lawmakers will return to Washington the week of October 19th to begin work on several looming deadlines, including the need to raise the debt ceiling by early November and another government funding battle in early December.

    House Committee Begins Review of Drug Abuse Legislation
    On Thursday, the House Energy and Commerce Health Subcommittee conducted the first of a two-part hearing on the nation’s drug abuse crisis. The hearings are designed to provide committee members with a better understanding of the root causes of the drug abuse crisis and review seven different legislative approaches for prevention and treatment. The first panel of witnesses was comprised of government witnesses, including Mr. Michael Botticelli, Director of the White House Office of National Drug Control Policy; Dr. Richard Frank, HHS Assistant Secretary for Planning and Evaluation; and Mr. Jack Riley, Deputy Administrator of the DEA.

    One of the bills that is of particular interest to ACEP, the “Synthetic Drug Control Act of 2015” (H.R. 3537), is sponsored by Reps. Charlie Dent (R-PA) and Jim Himes (D-CT). This bill will add more than 200 synthetic compounds to Schedule I of the Controlled Substances Act and make it easier to prosecute manufacturers, distributors and sellers of illicit synthetic drugs. Emergency physician and toxicologist, Dr. Kenneth Katz from the Lehigh Valley Health Network, will be testifying on behalf of ACEP about this bill on Tuesday, October 20 as a witness on the second panel.

    To see the list of legislation proposals, or to view the testimony of the first panel, click here.

    Senate Committee Approves Bill to Help Prevent Suicide and Increase Early Identification of Mental Illness
    Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee approved S. 1893, the “Mental Health Awareness and Improvement Act,” by voice vote. The bill is sponsored by the committee’s chairman Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) and it focuses on suicide prevention, helping children recover from traumatic events, mental health awareness for teachers and first responders, and assessing barriers to integrating behavioral health and primary care.

    S. 1893 is one component of a larger effort to promote mental health reforms in the 114th Congress. ACEP continues to work with Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) and Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX) to advance their bills to provide more comprehensive mental health reforms.

    President Signs Bill to Modify Affordable Care Act
    On Wednesday, President Obama signed the “Protecting Affordable Coverage for Employees (PACE) Act” into law modifying the Affordable Care Act (ACA) for the 14th time since its enactment in 2010. Under the ACA, small businesses of less than 50 employees have special rules (rating restrictions, beneficiary requirements, etc.) that have led to higher costs for employers. Beginning in 2016, those rules were set to extend to businesses with 51-100 employees. The PACE Act restores the 50-employee threshold for the small group health insurance market and provides states with the flexibility to decide how to classify businesses of 51-100 employees.

    House Budget Approves ACA Reconciliation Plan
    The House Budget Committee has reported out its reconciliation instructions to repeal major Obamacare provisions and deny funding to Planned Parenthood for one year. Earlier today in a committee mark-up, the plan was approved 21-11 along party lines. The legislation would repeal the individual and employer mandates, the Cadillac and medical device taxes, IPAB, the auto-enrollment requirement for large companies and the Prevention and Public Health Fund. The House is expected to vote on the legislation during the week of Oct. 19.

    SAVE-THE-DATE!! - 911 Legislative Network Teleforum
    Wednesday, October 21 @ 2:00 pm (EDT)
    With Special Guest Sen. Chris Murphy (D-CT)

    Sen. Murphy will provide the latest update on mental health reform efforts in the U.S. Congress and then be available for questions from teleforum participants.

    More details about the upcoming teleforum with Sen. Murphy will be provided next week.

  • Weekly Update, October 2, 2015

    Government Shut-down Averted
    Just hours before a midnight deadline to keep the government open, President Obama signed a stopgap spending bill Wednesday which funds federal agencies through Dec. 11 and averts a government shutdown. The bill is intended to buy more time for President Obama, Senate Majority Leader Mitch McConnell (R-KY), outgoing Speaker John Boehner (R-OH) and Boehner's successor to reach a comprehensive, long-term budget agreement.

    The stopgap measure sailed through the Senate earlier Wednesday by a vote of 78-20. The House passed the bill, 227-151, with most Republicans voting against it, since it did not strip out funding for Planned Parenthood.

    But more obstacles stand in the way of a comprehensive budget deal this winter. Obama and Democrats are seeking to lift caps on domestic and defense spending put in place by the 2011 Budget Control Act, better known as “sequestration.” Some Republicans have expressed interest in raising defense spending, but the party is almost unanimously opposed to boosting funding for domestic programs.

    House Republicans to Hold Leadership Elections on Oct. 8
    Majority Leader Kevin McCarthy (R-CA) remains the favorite to replace the current Speaker of the House John Boehner (R-OH) who announced he will step down on October 30. Some members are also clamoring for a change to the rules that would force candidates for speaker, majority leader and whip to vacate their existing positions in order to run. The matter was discussed in a closed-door, members’ only meeting Tuesday night, but no decisions were made.

    Assuming things go according to plan, McCarthy’s elevation would leave his position open, and Majority Whip Steve Scalise (R-LA) and Budget Chairman Tom Price (R-GA), an orthopaedic surgeon, will face off.

    If Scalise wins the majority leader race, at least four lawmakers are eying the whip slot. Chief Deputy Whip Patrick T. McHenry (R-NC), Rules Chairman Pete Sessions (R-TX) and Reps. Markwayne Mullin (R-OK) and Dennis A. Ross (R-FL) are said to be interested.

    EMTALA Liability Bill Garners More Support in the House
    One of ACEP's top legislative priorities, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) continues to garner Congressional support. Since last reported in the Update, several Members of Congress have been added to the House bill bringing the overall total co-sponsorship in the House to 85 and six in the Senate. The most recent additions include: Reps. Chuck Fleischmann (R-TN), Gus Bilirakis (R-FL), Renee Ellmers (R-NC), Tim Walberg (R-MI), and David Young (R-IA).

    ACEP Urges Key House Committee to Take Up Mental Health Reform
    ACEP joined with 19 organizations in the mental health and substance abuse community to send a letter this week to House Energy and Commerce Chairman Fred Upton (R-MI) and Ranking Member Frank Pallone (D-NJ) urging the committee to undertake and markup meaningful mental health reform legislation. Mental health reform was a key issue discussed by the more than 500 ACEP members who attended the ACEP Leadership and Advocacy Conference and participated in ACEP’s Lobby Day on Capitol Hill in May.

    Senate Passes Mental Health Demonstration Program
    The U.S. Senate Tuesday night approved by unanimous consent legislation (S. 599) to extend the Medicaid Emergency Psychiatric Demonstration Program, which allows eligible states to pay certain institutions for mental disease for emergency psychiatric care provided to Medicaid enrollees aged 21 to 64. The bill, which now goes to the House of Representatives for consideration, would extend the program through September 2016, as long as it does not increase Medicaid spending, and to publicly-owned IMDs. It then would allow the Department of Health and Human Services to extend the program for three more years and to more states, subject to the same budget-neutrality standard; and require the agency to recommend by April 2019 whether to make the program permanent.

    House Action on Reconciliation
    On Wednesday, the House Energy and Commerce Committee approved reconciliation language blocking federal funds to Planned Parenthood for one year and rescinding unused funds from the ACA's Prevention and Public Health Fund. The language passed 28-23 along party lines.

    The measure is just one piece of House Republicans' larger strategy to repeal Obamacare and defund Planned Parenthood through the reconciliation process. Two other committees - Ways and Means and Education and Workforce - also approved their pieces of the bill that the House Budget Committee is expected to take up next week.

    When those pieces are put together, the reconciliation bill will also repeal the ACA's individual and employer mandates, the Independent Payment Advisory Board charged with recommending Medicare cuts if spending rises above a certain level, along with two major taxes used to pay for the healthcare law: a 40 percent tax on high-cost health plans, called the "Cadillac Tax," and a 2.3 percent excise tax on medical devices.

    The Budget Committee will compile all recommendations into a legislative package and send it to the full House for consideration, without an opportunity for lawmakers to offer amendments. It is unclear when the full House would act on this legislation, but the reconciliation process will allow Republicans to get the repeal bill to President Obama because the legislation will not be subject to a filibuster in the Senate and will need only 51 votes there. The president however is expected to veto the package.

    Senate HELP Committee Hearings
    On Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee convened a hearing to review the following bills:

    • S. 799 Protecting Our Infants Act of 2015: The bill requires the Agency for Healthcare Research and Quality to report on prenatal opioid abuse and neonatal abstinence syndrome.
    • S. 1893 Mental Health Awareness and Improvement Act of 2015: The bill seeks to reauthorize and improve programs related to mental health and substance abuse.
    • S. 481 Improving Regulatory Transparency for New Medical Therapies Act: Among other things, this bill amends the Federal Food, Drug, and Cosmetic Act and the Public Health Service Act to delay the effective date of approval of a drug, biological product, or animal drug for which the Food and Drug Administration (FDA) recommends controls under the Controlled Substances Act until the Department of Justice (DOJ) issues a final interim rule for the drug. This delay also applies to conditional approval and indexing of animal drugs.

    All three bills were unanimously advanced by voice vote. More information on the markup may be found here.

    ACEP Receives TCPI Grant
    ACEP is one of 39 health care organizations selected to participate in the Transforming Clinical Practice Initiative (TCPI), announced on Tuesday by Health and Human Services Secretary Sylvia M. Burwell. As a Transforming Clinical Practice Initiative (TCPI) Support and Alignment Network, ACEP will support up to 34,000 clinicians to expand their quality improvement capacity, learn from one another, and achieve common goals of improved care, better health and reduced cost. The network will lead quality improvement learning projects to help clinicians reduce costs and improve patient care.

    This award builds on work that ACEP is doing to improve value through projects, such as its Clinical Emergency Data Registry (CEDR), Choosing Wisely initiative and Geriatric Emergency Department Guidelines. The project will be co-led by Arjun K. Venkatesh, MD MBA, MHS, of Yale University School of Medicine and Jeremiah D. Schuur, MD, MHS, FACEP, of Brigham and Women's Hospital. For more information on the Transforming Clinical Practice Initiative, please visit: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/ 

  • Weekly Update, September 25, 2015

    A historic week in Washington DC and in the halls of congress came to a tumultuous close today. The week began on Tuesday with the much anticipated visit by Pope Francis. In just 48 hours, he met with President Obama, gave guidance to U.S. bishops, canonized a saint, delivered a first-ever papal address to a joint meeting of Congress, and ministered to the homeless. Pope Francis's two-day tour has enchanted our nation's capital, upending daily routines — and travel plans — as roads closed, security ramped up and thousands flocked to catch a glimpse of the cassocked pontiff as he traversed the city.

    In his unprecedented address to Congress on Wednesday — the longest speech he has ever given in English — Pope Francis showed a deep appreciation for the American dream while also pressing lawmakers to come together to help the world's poor and dispossessed.

    His 50-minute speech marked the first time a pope has addressed Congress in the nation's history, and the chamber included legislators’ and their guests, Supreme Court justices, members of President Obama's cabinet and reporters.

    Pope Francis was careful not to step too deeply into the partisan fights currently swirling around Capitol Hill — a topic of much speculation prior to the speech. Lawmakers in both parties appeared mesmerized as the Pope Francis urged them to shed their differences for the sake of people's well-being.

    For all the frenzied anticipation, the visit itself was brief. Francis arrived at the Capitol shortly after 9 a.m. By 11:30, he'd already left Capitol grounds to visit a homeless shelter down the street.

    Speaker Boehner’s Resignation
    And in the middle of it all was Rep. John Boehner (R-Ohio), who abruptly announced today that he will step down from the Speakership of the House of Representatives and retire from Congress on October 30. The catholic Speaker has been inviting popes to Capitol Hill since he arrived in Congress more than two decades ago. Francis was the first to accept.

    The 13-term Ohio Republican shocked his Republican caucus early this morning when he announced his decision in a closed-door session - just one day after the historic speech by Pope Francis at Boehner's request - a high point of his congressional career.

    The Politics of the Resignation
    Conservatives members of the GOP caucus have been demanding that any legislation to keep the government operating past next Wednesday's deadline must strip Planned Parenthood of government funds. The dispute was threatening Boehner's speakership and upending the GOP caucus.

    Boehner's decision to resign removes the possibility of a damaging vote to strip him of his speakership, a scenario that grew more likely amid the conservative clamor over a shutdown. As speaker, his tenure has been defined by his early struggles to reach budget agreements with President Barack Obama and his constant struggles with tea party conservatives who demanded a more confrontational approach.

    In 2013, conservatives drove him to reluctantly embrace a partial government shutdown in hopes of delaying implementation of the Affordable Care Act. Now, tea party lawmakers have been pressing him to retry the tactic to try to take away federal funding from Planned Parenthood following the disclosure of controversial videos involving its practices of procuring fetal tissue for research purposes.

    Boehner’s greatest impact on health care policy and physician related issues came earlier this year when he and Minority Leader Nancy Pelosi negotiated an unprecedented deal to replace Medicare's sustainable growth rate formula, better known as the “doc fix.” They then shepherded the package through both chambers with large bipartisan support. The legislation also included a clean two-year extension of the Children's Health Insurance Program, which has enjoyed broad, bipartisan support.

    Boehner's legacy on the Affordable Care Act is marked by repeated, ill-fated attempts to repeal - or at least cripple - the president's signature domestic achievement. A pending lawsuit led by Boehner could still seriously damage the law's legacy. House Republicans are challenging the Obama administration's authority to fund the ACA's cost-sharing subsidies, which help low- and middle-income families afford out-of-pocket health costs. Earlier this month, a federal judge ruled that House Republicans had standing to pursue the lawsuit, a decision that surprised many legal observers.

    Rumors are rampant regarding Boehner’s successor. House Majority Leader Kevin McCarthy (R-CA) is the presumed favorite. He became majority leader following Eric Cantor’s surprise primary loss in 2014.

    ACEP President Michael Gerardi, MD, FACEP had the opportunity recently to speak with Rep. McCarthy during at a luncheon in Washington DC which he attended on behalf of NEMPAC, ACEP’s political action committee. “I found Rep. McCarthy to be both informed and engaged in many of the issues that ACEP is focused on in the current Congress including mental health reform, medical liability relief, and the challenges emergency physicians face on a daily basis to provide quality, affordable care to thousands of patients who have little or no access to other health care options," said Dr. Gerardi.

    Shutdown or No Shutdown
    Senate Majority Leader Mitch McConnell on Thursday began laying the groundwork for the chamber to advance a “clean” continuing resolution to fund the government beyond the Sept. 30 deadline. Earlier on Thursday, Senate Democrats (except Sen. Manchin from WV) and some Republicans joined together to block consideration of bill that included language to defund Planned Parenthood. Immediately after the chamber rejected this initial CR, McConnell began teeing up a vote on another version of the 10-week bill without language targeting Planned Parenthood.

    The cloture vote on the “clean” CR is expected to occur Monday at 5:30 p.m.

    House discussions are going on behind closed doors. Prior to Boehner’s announcement today, House GOP leaders were discussing the possibility of using the reconciliation process to defund Planned Parenthood and sending a bill to President Barack Obama's desk. House GOP leaders are tentatively planning a markup of reconciliation legislation by Ways and Means and two other authorizing committees next week, but no dates have been set.

    Amidst the turmoil within the House leadership, Congress faces ‘must-do’ issues including another debt limit hike this fall, not to mention the budget and a highway bill deal.

    ACEP to Testify at Upcoming Synthetic Drug Hearing
    As reported last week, Rep. Charlie Dent (R-PA) and Jim Himes (D-CT) held a press conference last Friday to announce the introduction of the ACEP-supported legislation, “Synthetic Drug Control Act of 2015” (H.R. 3537), which will add more than 200 known synthetic drugs to Schedule I of the Controlled Substances Act and facilitate federal prosecution of the manufacturers, distributors and sellers of synthetic drugs. The legislation continued to build momentum this week when Rep. Dent was notified that the House Energy and Commerce Health Subcommittee will be conducting a hearing on Oct. 8 to discuss this legislation and other issues related to drug misuse and abuse.

    ACEP immediate past president Alex Rosenau, DO, CPE, FACEP, will be one of the witnesses at the hearing and he will discuss H.R. 3537 and the impact synthetic drugs are having on emergency department patients.


    Senate HELP Mark-up
    On Wednesday, September 30th the Senate Health, Education, Labor and Pensions (HELP) Committee will hold an Executive Session markup of health-related legislation. The Mental Health Awareness and Improvement Act of 2015 introduced by Senators Murray (D-WA) and Alexander (R-TN) will be one of the bills discussed. The Murray/Alexander mental health proposal is less comprehensive than the broader reform efforts underway by Senators Cassidy (R-LA), Murphy (D-CT) and Rep. Tim Murphy (R-PA). For more information on the pending mark-up, please click here.

    Health Information Technology Hearing
    The Senate Health, Education, Labor and Pensions (HELP) committee will continue its series of health information technology hearings next week with a hearing titled “Achieving the Promise of Health Information Technology.” To view the hearing, please click here.

  • Weekly Update, September 18, 2015

    Next Week
    The House will be in session only Thursday and Friday of next week due to the Jewish holiday and visit to Washington, D.C. by Pope Francis. The Republican-controlled House provided itself with the authority to ignore normal procedures during these two days by giving the Speaker of the House the power to move a bill from the Rules Committee to the House floor on the same day. This same-day consideration authority is known as "martial law" within the House. It's a defensive measure designed to provide flexibility to the leadership when deadlines are looming, as is the case with end of the fiscal year (Sept. 30) when funding for government programs will run out unless Congress takes action.

    Synthetic Drug Bill Introduced in House
    Earlier today, Rep. Charlie Dent (R-PA) held a press conference to announce his introduction of the ACEP-supported, H.R. 3537 "Synthetic Drug Control Act." Congressman Dent was joined by ACEP's immediate past president Alex Rosenau, DO, CPE, FACEP, who described how he and his emergency medicine colleagues see first-hand the threats of these dangerous synthetic drugs, how they harm users and how use of synthetic marijuana has grown substantially during the past few years. The legislation will add more than 200 known synthetic drugs (identified by the DEA) to Schedule I of the CSA and facilitate federal prosecution of the manufacturers, distributors and sellers of synthetic drugs (not individuals for possession). ACEP also supported legislation introduced by Rep. Dent in 2011 (enacted in 2012) that created the original ban on synthetic drugs and provided the DEA with the authority to temporarily schedule a new substance for up to three years.

    To view ACEP's letter of support, click here.

    Pictured above at Capitol Hill Press Conference on combating synthetic drug abuse 9/18/15 Rep. Charlie Dent (R-PA), Rep.David Jolly (R-FL), DC Police Commander, Rep. Jim Himes (D-CT), Rep. Eleanor Holmes Norton (D-DC) and ACEP immediate past president Dr. Alex Rosenau DO, CPE, FACEP.

    House Approves Bill to Help Reduce Frivolous Lawsuits
    Also today, the U.S. House of Representatives approved H.R. 758, the "Lawsuit Abuse Reduction Act" (LARA), by a vote of 241 to 185. This bill, sponsored by Rep. Lamar Smith (R-TX), would impose mandatory sanctions on lawyers who file meritless suits (violation of Rule 11) in federal court. The intent of the legislation is to reverse the 1993 amendments to Rule 11 that allow parties and their attorneys to avoid sanctions for making frivolous claims by withdrawing them within 21 days after a motion for sanctions has been served.

    Senate Hearing Examines HIT Issues
    On Wednesday morning, the full Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing entitled, "Achieving the Promise of Health Information Technology: Improving Care Through Patient Access to Their Records." Testifying at the hearing, Raj Ratwani, scientific director for MedStar Health’s National Center for Human Factors in Healthcare (and Assistant Professor of Emergency Medicine at Georgetown University School of Medicine), recommended refocusing certification requirements to promote "true usability," among other changes. Also testifying at the hearing was Kathy Giusti, executive chairman of the Multiple Myeloma Research Foundation, and Eric Dishman, general manager for health and life sciences at Intel Corp. Concerns regarding interoperability of HIT systems and the burdens posed by Meaningful Use standards were among the many issues discussed. More information on the hearing can be found here.

    Senate Holds Hearing on Pending VA Legislation
    Also on Wednesday, the Senate Veterans' Affairs Committee held a hearing on several pending bills related to veterans' issues. Specifically, ACEP has been vocally supportive of Sen. Mazie Hirono's (D-HI) bill S. 1450, the "Department of Veterans Affairs Emergency Medical Staffing Requirement and Retention Act." The legislation would better align the Veterans Health Administration (VHA) staffing policy to that of the private sector making VHA employment more appealing to physicians who choose to serve veterans. ACEP continues to work with House counterparts to ensure companion legislation is introduced in that chamber.

    To view ACEP's letter of support, click here. To view ACEP's letter to the chairman and ranking member of the Senate VA Committee in August urging them to include S. 1450 in the next mark-up, click here

    ACEP has also expressed support for another bill, S. 1693, reviewed by the committee on Wednesday (and also sponsored by Sen. Hirono) that would eliminate the 24-month rule (veteran eligibility to receive VA medical care dependent on having received care at a VA center within the previous 24 months) for newly enrolled veterans who are still awaiting their initial VA health care visit.

    To view the hearing and learn more about other bills discussed, please click here.

    EMTALA Liability Bill Support Grows
    Rep. Glenn Thompson (R-PA) recently signed back on in support of H.R. 836, the "Health Care Safety Net Enhancement Act of 2015," one of ACEP's top legislative priorities. Earlier this summer, Rep. Thompson toured Mt. Nittany Medical Center in State College, Pennsylvania with Dr. Theodore Ziff.

    NEMPAC and ACEP Advocacy Activities at ACEP15 in Boston


  • Regulatory Edition, September 14, 2015

    ACEP Comment Letter on the Proposed 2016 Medicare Physician Fee Schedule
    In our comment letter, ACEP urged CMS to:

    • Allow specialists, including emergency physicians who provide advance care planning services, to use the new CMS advance care planning codes.
    • Remove restrictive definitions that only primary care practitioners to provide care coordination services.
    • Promote development of alternative payment models that include hospital-based physicians.
    • Clarify that the exemption for advanced imaging applies to the emergency department for the purposes of medical screening exams.

    MedPAC Turns Attention to Free Standing EDs at its September Meeting
    Responding to queries from a few Commissioners last spring, staff conducted a largely qualitative study (based on interviews) of growth of free standing EDs, both provider-based and independent. The objective was to understand the effects of this fast growing sector on beneficiary access and overall costs to the Program. By 2015, hospitals (mostly large urban and suburban systems) were operating 387 freestanding EDs, and the number of independent EDs (not eligible to take Medicare or Medicaid payment) is more than 170 – 90% of which are located in TX, and many are operated by large, for-profit companies. MedPAC may consider recommending a site of service modifier for provider-based freestanding EDs to presumably determine whether facility payment should be on par with the hospital ED, and to learn more about overall costs and beneficiary financial liability. Commissioners expressed concern that cost growth per capita for ED services is grew at 7% between 2008 -2013. Since MedPAC’s purview is limited to Medicare, its review of independent EDs will be limited at this point.

    CMS Webinar on Severe Sepsis/Septic Shock Webinar Monday September 21 at 2 p.m. ET
    The Centers for Medicare & Medicaid Services (CMS) is offering a three-part educational series on The Clinician Perspective on Sepsis Care: The Early Management Bundle for Severe Sepsis/Septic Shock. The series will provide insight into the clinical perspective on the Severe Sepsis/Septic Shock Bundle and will help physicians better understand this crucial clinical quality measure. Part two of the series will take place on Monday September 21 at 2 p.m. ET. To learn more or to register, visit https://cc.readytalk.com/cc/s/registrations/new?cid=77v8or55htac

    CMS Webcast: Overview of the 2014 Annual Quality and Resource Use Reports (QRUR) Thursday, September 17, 2015, 2:30 PM - 4:00 PM Eastern Time
    This CMS MLN Connects® Event provides an overview of the 2014 Annual QRUR and explains how to interpret and use the information in the report. The 2014 Annual QRURs contain quality and cost performance data for CY 2014, which is the performance period for the Value-Based Payment Modifier that will be applied to physician payments for items and services furnished under the Medicare Physician Fee Schedule for groups of 10 or more eligible professionals in 2016. Learn more about the reports on the 2014 QRUR website. The event will be more meaningful if you have your QRUR in front of you to follow along. Visit How to Obtain a QRUR and access your report prior to the event.

    2014 Annual Quality and Resource Use Reports (QRURs) Available from CMS
    The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice by their Taxpayer Identification Number (TIN). The 2014 Annual QRURs show how your group performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. The QRUR shows how the Value Modifier will apply to your payments under the Medicare Physician Fee Schedule (MPFS) who bill under the group’s TIN in 2016. Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR. CMS established a 60-day Informal Review Period that begins after the release of the 2014 Annual QRURs, to request a correction of a perceived error in their 2016 Value Modifier calculation. The informal review period for the 2016 Value Modifier is open from September 9, 2015 through November 9, 2015. Due to this deadline ACEP strongly recommends that your group download and review your QRUR as soon as possible. Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhhs.gov or 888-734-6433 (select option 3).

    PQRS Payment Adjustment Review Period Underway
    Eligible professionals and group practices participating in the Physician Quality Reporting System (PQRS) who believe they were incorrectly assessed a negative payment adjustment for 2016 may ask CMS to review their adjustment determination through Nov. 9 by submitting an informal review request at the quality reporting portal. Review decisions are final and should be received within 90 days. Individual EPs, Comprehensive Primary Care practice sites and group practices participating in PQRS must satisfactorily report quality data for covered professional services in 2014 to avoid a 2% payment reduction in 2016 and receive a 2014 PQRS incentive payment. For more information, visit www.cms.gov or see the CMS factsheet.
  • Weekly Update, September 11, 2015

    The peace and quiet on Capitol Hill over the last five weeks came to an end on Tuesday when Congress returned to a packed agenda filled with “must do” items. First on the agenda is the consideration of resolution of disapproval of the international accord on Iran’s nuclear program. 42 Senate Democrats have announced support for the international accord which is enough to sustain President Obama’s veto of a resolution of disapproval. House Minority Leader Nancy Pelosi (D-CA) also expressed confidence last week that her caucus will vote in sufficient numbers to protect the president’s veto, since more than 100 House Democrats have announced their support. The House has a vote series planned on the agreement today but is holding off on its disapproval vote, for now.

    Next on the agenda is figuring out how to keep the federal government funded past September. In the wake of controversial videos regarding Planned Parenthood's use of fetal tissue, many House conservatives, as well as multiple Republican senators running for president, want to block federal funding for Planned Parenthood through a stopgap spending bill Congress will have to pass in order to avoid a shutdown on Oct. 1. But other lawmakers are wary of another potential shutdown threat following the disastrous showdown in 2013 over Obamacare.

    Emergency Medicine Team Promotes Mental Health Reform on Capitol Hill
    On Wednesday, ACEP President Mike Gerardi, MD, FACEP, Society of Emergency Medicine Physician Assistants (SEMPA) President Lynn Scherer and Emergency Nurses Association (ENA) President Matt Powers met with key policymakers on Capitol Hill to promote passage of comprehensive mental health reform. The group presented an emergency department perspective on the challenges of properly caring for mental health patients and made the case for why it is so important for Congress to provide additional mental health resources to ensure these patients receive care at the right time and in the right place. Among others, the group met with Sen. Bill Cassidy (R-LA), sponsor of the Senate's most comprehensive mental health reform legislation; majority and minority health policy staff for the Sen. Health, Education, Labor, and Pensions (HELP) Committee; Chief of Staff for Rep. Tim Murphy (R-PA), sponsor of the House comprehensive mental health reform legislation; and the lead Democrat for the House bill, Rep. Eddie Bernice Johnson (D-TX).

               

    House Passes PDMP Reauthorization
    On Tuesday, the U.S. House of Representatives approved the "National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization Act" (H.R. 1725) by voice vote. The legislation, sponsored by Reps. Ed Whitfield (R-KY) and Joseph Kennedy (D-MA), would provide states with grant funding to foster the use of prescription drug monitoring programs (PDMPs) to help fight the growing prescription drug abuse epidemic. The measure will now be sent to the U.S. Senate for consideration.

    ACEP Members Host ED Visits during Congressional Recess
    It is ACEP's goal, with your help, to continue to strengthen ties with Members of Congress both in Washington DC and back home in congressional districts. Over the recent August congressional recess, ACEP 911 Network members scheduled several ED tours and meetings for legislators and their staff to help further their understanding of the challenges faced by emergency physicians on a day-to-day basis when delivering care to thousands of patients - their constituents. It was ACEP’s goal to schedule at least one visit per week throughout the country during the August recess. Thank you to all members who have participated in these important and necessary meetings. Recent visits include:

    • Dr. Lars Blomberg for Rep. Crescent Hardy (R-NV) at Centennial Hills Hospital in Las Vegas, NV
    • Dr. William Gallea for the staff of Rep. Steve Daines (R-MT) at St. Peters Hospital in Helena, MT
    • Dr. Frederick Schiavone for Rep. Lee Zeldin (R-NY) at Stony Brook Medical Center in Stony Brook, NY
    • Dr. Robert Powell for Rep. David Brat (R-VA) at Bon Secours St. Mary’s Hospital in Richmond, VA
    • Dr. David Larson for Rep. Tom Emmer (R-MN) at Two Twelve Medical Center in Chaska, MN
    • Dr. Louise Prince for Rep. John Katko (R-NY) at Upstate University Hospital in Syracuse, NY
    • Dr. Charles Pattavina for Rep. Bruce Poliquin (R-ME) at St. Joseph Hospital in Bangor, ME
    • Dr. Adam Barkin for the staff of Rep. Ken Buck (R-CO) at Sky Ridge Hospital in Lone Tree, CO

    "Triple E Campaign" - How You Can Help
    Efforts to “Expand, Enhance and Engage” the ACEP 911 Legislative Grassroots Network are going full speed ahead, under the leadership of Dr. Andy Bern. You can help your ACEP state chapter earn points toward the contest that culminates at ACEP15 in Boston by recruiting new members to the 911 Network, responding to Action Alerts, and participating in ACEP hosted teleforums on important legislative issues like mental health reform.   To see how your state chapter is doing and what you can do to help, check the progress of the campaign on ACEP Grassroots Advocacy Center here. More information also can be found in a recent article in the online version of ACEPNow.

  • Congressional Recess, Aug. 7, 2015

    The House and the Senate have adjourned for the August recess, and will reconvene on September 8.

    Mental Health Reform
    Several bills related to mental health have been introduced in the Senate in the past week. On July 29, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) introduced S. 1893, the "Mental Health Awareness and Improvement Act," which would support suicide prevention programs, train school personnel to recognize mental illnesses, help children recover from traumatic events, and conduct several studies related to substance abuse and mental health services availability. This bill is similar to legislation (S. 689) the Senate overwhelmingly approved in 2013 during the gun control debate, although the underlying bill never advanced.

    On Wednesday, Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) introduced a comprehensive mental health reform bill, S. 1945, as a companion to the legislation (H.R. 2646) introduced in the House earlier this year by Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX). While there are differences between the two bills, there are also many similar provisions that are of interest to ACEP, including: creation of an Assistant Secretary for Mental Health and Substance Use Disorders and the National Mental Health Policy Lab, extension of the Assisted Outpatient Treatment (AOT) grants, promotion of telemedicine services, liability protections for volunteers at Community Health Centers and Community Behavioral Health Centers, expansion of the mental health workforce, clarification of HIPAA privacy rules for patients with mental illness and their caregivers, elimination of the Medicaid same-day and IMD exclusions, improving credentials for peer review and advisory council members, and efforts to implement mental health parity in health plans.

    Also on Wednesday, Sen. John Cornyn (R-TX) introduced legislation, S. 2002, intended to strengthen the National Instant Criminal Background Check System (NICS) to clarify the scope of mental health records required to be reported by states and to assist state and local governments' transition incarcerated mentally ill patients out of custody.

    Although efforts fell apart in the last Congress, momentum around mental-health reform is now building in Congress and gathering bipartisan support as a response to mass violence and the reality that gun control is a nonstarter. Lawmakers leading the push say they are finally in a good position to pass a bill, even as election season heats up and the window for legislating narrows. During an interview with POLITICO, Sen. Murphy noted, “This could be one of the issues that survives the political calendar. “By virtue of the fact that a conservative Republican from Louisiana and a progressive Democrat from the Northeast are working together, you can get a sense that the politics around this issue are different than others."

    Senators Cassidy and Murphy say they hope the HELP Committee will take it up their bill when Congress returns from August recess. On the other side of the Capitol, the House Energy and Commerce Committee has committed to focusing its attention on mental health reform when lawmakers return to Washington after the August recess.

    Please be on the lookout for an Action Alert asking you to contact your two U.S. Senators and House member to ask for their “co-sponsorship” of the Senate and House mental health bills, S.1945 and H.R.2646.

    ACEP Letters of Support for Recently Introduced Legislation
    ACEP sent letters of support to the sponsors of three bills previously reported on in the Weekly Update. The letters are available for review on the ACEP Website.

    S.1648 - The "Rural Emergency Acute Care Hospital (REACH) Act" introduced by Sens. Chuck Grassley (R-IA) and Cory Gardner (R-CO) would help rural Critical Access Hospitals convert to a newly created category for "Rural Emergency Hospitals" (REHs). These hospitals would have the option to become a REH if they eliminate all inpatient services, maintain 24-hour emergency medical care, and observation that doesn't exceed 24 hours (or one midnight), among other things.The Medicare payment structure for REHs would be 105% of reasonable costs, as opposed to the 101% of reasonable costs for CAHs. 

    In addition, ACEP worked closely with Sen. Grassley’s office to insert language that would expand the Public Health Service Corps loan forgiveness program to emergency physicians who work at an REH and remove the current financial disincentive for emergency medicine residents to do rotations at rural hospitals.

    S.1450 - The “Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act” would promote the recruitment and retention of emergency physicians and hospitalists in the VHA system by allowing more flexibility for their irregular work schedules.

    H.R. 2702 – the “Safety Through Informed Consumers (STICRS) Act,” introduced by Rep. Todd Rokita (R-IN) which would modify the National Highway Traffic Safety Administration’s (NHTSA) 5-Star Safety Ratings Programs.

    Notice Act Signed into Law
    President Obama signed into law the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which requires hospitals to notify patients if they are categorized as “outpatient” with regard to their Medicare coverage.

    DeSalvo Nomination Moves Forward
    Karen DeSalvo is one step closer to Senate confirmation as assistant secretary of health after the Senate HELP Committee gave unanimous consent to her nomination on Thursday. The Office of the National Coordinator for Health Information Technology (ONC) chief’s nomination next heads to the Senate floor for consideration, but it’s unclear when — or if — lawmakers will vote on her confirmation. There are 67 other Obama nominees pending votes, according to the Senate calendar.

    What to Expect in September when Congress Returns
    Congress has a contentious to-do list when members return in September that includes consideration of the Iran nuclear deal, a spending debate that could be complicated by abortion politics, and the need to pass a long-term bill to pay for repairs to the nation’s crumbling roads and bridge. Before leaving for the recess, Congress passed a three-month extension of financing for the program. Add to it, the looming expiration of the Treasury Departments’ borrowing authority and need to raise the debt limit, most likely in December.

    While Congress achieved many major accomplishments this year, including the final broad revisions to the Patriot Act, repeal of the SGR and passage of a new formula for paying doctors under Medicare, and two bills that may be reconciled to fix the No Child Left Behind law, other legislation continues to be elusive.

    The first hurdle on the horizon comes Sept. 30 when funding for federal agencies will expire. Some Republicans said this could lead to a government shutdown if Congress does not move to take away money from Planned Parenthood. Congressional leaders hope to at least pass a temporary funding measure before an address by Pope Francis to a joint meeting of Congress on Sept. 24.
  • Weekly Update, July 31, 2015

    The House of Representatives is in recess and will return to business after Labor Day on September 8. The Senate will be in session through next week and is expected to recess on August 7 and will also return on September 8.

    Next week, the Weekly Update will highlight mental health reform legislation recently introduced in the Senate and will provide a look at the must-do items that Congress will face when they return from the August break.

    Hospital Payment Reform Bills Introduced in House
    On Wednesday, several members of the House Ways and Means Committee introduced three legislative proposals to reform Medicare reimbursements for hospital services. These bills are intended to modify how Disproportionate Share Hospital payments are distributed, address differences in site of service surgical payments, and update the Indirect Medical Education (IME) payment methodology. This is a continuation of discussions surrounding hospital payment modifications that began last fall and that are ultimately designed to reimburse hospitals for the quality, not quantity, of care provided in much the same manner as the physician payment reform enacted earlier this year.

    H.R. 3288, the "Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015," introduced by committee members Kenny Marchant (R-TX) and Charles Boustany (R-LA), would provide Medicare DSH reimbursements to hospitals through lump-sum payments (rather than as a per discharge add-on payment) and increase DSH funding to hospitals located in states that have not expanded their Medicaid programs through the Affordable Care Act (ACA). The new spending created by this legislation would be off-set by recouping all ACA subsidy overpayments.

    H.R. 3291, the "Medicare Crosswalk Hospital Code Development Act of 20015," introduced by committee Chairman Paul Ryan (R-WI), would create a site-neutral payment for (at least 10) similar inpatient and outpatient surgeries.

    H.R. 3292, the "Medicare IME Pool Act of 2015," introduced by the Health Subcommittee Chairman Kevin Brady (R-TX), would provide each teaching hospital with a lump-sum payment (twice per month) to reimburse IME costs, instead of paying an additional percentage based on each inpatient case. This new system would be effective beginning with cost reporting periods that end either during or after FY 2019.

    For more information about these bills, click here to view the House Ways and Means Committee press release.

    House Bill Introduced to Update Emergency Medical Kits
    Also on Wednesday, Reps. Sean Patrick Maloney (D-NY) and Richard Hanna (R-NY) introduced legislation that would require the Federal Aviation Administration (FAA) to update airplane emergency medical kits (EMKs) to account for pediatric medications and equipment. ACEP was joined by the American Academy of Pediatrics, National Association of State Emergency Medical Services Officials, Emergency Nurses Association, and others endorsing this legislation. Click here to read ACEP’s letter of support.

    Prescription Drug Reporting Bill Advances Out of Committee
    Earlier this week the House Energy and Commerce Committee marked-up six bills which will be considered by the full House of Representatives sometime this fall. Of particular interest to ACEP is H.R.1725, legislation sponsored by Rep. Ed Whitfield (R-KY) which seeks to reauthorize the National All Schedules Prescription Electronic Reporting Reauthorization Act, or NASPER Act. The NASPER program provides states grant funding to foster the use of prescription drug monitoring programs (PDMPs) to fight the growing prescription drug abuse epidemic gripping our nation. NASPER originally became law August 11, 2005, and is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the Department of Health and Human Services. To learn more about the legislation and view the full committee mark-up, please click here.

    Rural Health Hearing in the House
    The House Ways and Means Health Subcommittee held a hearing on Tuesday to discuss rural health care disparities created by Medicare regulations. The subcommittee hearing gave a platform to rural providers to discuss some of the most pressing issues currently impacting rural healthcare. Concerns such as the burdensome 96 hour rule, the lack of residency slots for new physicians and onerous regulations for physician supervision of nurse practitioners were discussed. To learn more about the panelists and recent hearing, please click here.

    Notice Act Clears Senate and Awaits President’s Signature
    The U.S. Senate unanimously approved legislation Monday night requiring hospitals across the nation to tell Medicare patients when they receive observation care but have not been admitted to the hospital. The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act (H.R. 876) was introduced by Congressmen Lloyd Doggett (D-TX-35) and Todd Young (R-IN-9) in the U.S. House of Representatives, which unanimously passed the bill in March of this year. The NOTICE Act will require hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours. Outpatient status affects a patient’s ability to receive Medicare coverage for post-acute care in a skilled nursing center.
    With the Senate approval, the legislation now heads to the President for his signature into law.

    ACEP continues to support the bipartisan, bicameral legislative effort by Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL), and Shelly Moore Capito (R-WV) and Representatives Joe Courtney (D-CT) and Joe Heck (R-NV), the Improving Access to Medicare Coverage Act of 2015 (S.843/H.R.1571) that would require time spent in observation be counted towards meeting the three-day prior inpatient stay that is necessary to qualify for Medicare coverage of skilled nursing center care.

    CMS Proposes Stricter Reporting Requirements for Medicaid MCOs
    In our latest comment letter, we express support for the draft regulation’s call for standards and verification of network adequacy, state supports to plans for inpatient psychiatric care, clarification that payment for emergency services can’t be denied on the basis of diagnoses or symptoms, streamlined enrollment processes for physicians, and greater transparency in state reporting. We remain concerned about the poor track record of states and CMS in Medicaid managed care plan oversight.

    Available for Public Comment: ACEP Draft Quality Measures for the 2016 Clinical Emergency Data Registry (CEDR)
    The American College of Emergency Physicians (ACEP), in conjunction with the generous support of the American Board of Emergency Medicine (ABEM), convened a Quality Measures Technical Expert Panel (TEP) to assess opportunities for the development of evidence-based performance measures for ACEP's Clinical Emergency Data Registry (CEDR). The ACEP Quality Measures TEP, which is a joint objective of ACEP’s Quality and Performance Committee, Clinical Data Registry Committee, Sepsis Expert Panel, and other clinical content experts, proposes this set of registry measures to promote the highest quality of emergency care with a focus on sepsis management and efficiency of care in the emergency department. The four week comment period began on Friday, July 24th and will close at 5:00 p.m. Central on Friday, August 21st. Please see the measure set here. Please submit your comments here.
  • Weekly Update, July 24, 2015

    Congressional Schedule
    The Senate and House of Representatives will be in session next week. Debate continues through the end of the month on must-do items including the President’s Iran nuclear deal and a long-term highway funding bill. The Senate is working through the weekend in order to pass a bill to fund our nation’s highway system. In addition, Senate Majority Leader Mitch McConnell plans to offer an amendment on Sunday to the highway funding bill to fully repeal Obamacare. The vote is all but guaranteed to fail to get the 60 votes required to overcome a filibuster. No Democrat has indicated that they would join Republicans on the measure. The vote will address a campaign pledge made by McConnell — as well as many of the freshman Republicans — to go after the president's health care law.

    Latest Trustees Report Gives Bleak Prognosis for Medicare
    The most recent report on the Medicare program’s trust fund claims it will become insolvent in the year 2030. This report is very similar to the projection that was issued last year. The Medicare Trustees conclusion means that if things remain on the current trajectory, the trust fund will only be able to meet its financial obligations for the next 15 years. The report indicates that per-beneficiary costs rose by 2.3 percent in 2014, the largest increase in three years. The increase was largely due to the 10.9 percent spike in the cost of Part D drug coverage, which was tied largely to the expense of the breakthrough treatments for illnesses such as hepatitis C. Heated debate continues on the cause and effect and whether the slowdown in costs can be credited to the Great Recession or the fledgling status of the enacted Obamacare law. Medicare costs have grown at historically low levels in recent years. The slowdown in spending rates has helped extend the deadline for when the trust fund will begin failing to meet its obligations. Since 2010, when the Affordable Care Act was passed, the insolvency date has been extended by 13 years.

    It is projected in the report that the controversial Independent Payment Advisory Board will be triggered for the first time in 2017. It is required to make recommendations for cuts to Medicare if costs exceed targeted growth rates, and some have derided the board as a potential means to ration care for seniors.

    Earlier this year the House voted out of committee and on the House floor to repeal IPAB. The House of Representatives voted 244-154 to abolish the Independent Payment Advisory Board (IPAB). There were 20 Democrats who joined with Republicans to co-sponsor the IPAB repeal bill but only 11 voted to repeal it because of objections to the offset, which cuts $8.25 billion from an ACA preventive health fund.

    The 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds can be viewed here.

    Senate HELP Hearing on Information Blocking
    ACEP supports the Senate Health, Education, Labor and Pensions Committee for holding the very important hearing on Thursday July 23rd on Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions. “Data blocking” serves as a real threat to achieving improved quality of care and patient outcomes when emergency physicians do not have the needed patient information at the bedside. Emergency physicians and hospitals need more flexibility to exchange information, and policy changes are also needed to hold vendors accountable for the design of interoperable products. Data blocking by vendors will only serve to slow the progress on the potential promise of electronic health records (EHRs) and Health Information Exchanges (HIEs).

    ACEP applauds AMA-President Steve Stack, MD, FACEP and Rep. Tom Price, MD, R-GA for hosting the Break the Red Tape: Electronic Health Records Town Hall on Monday, July 20, 2015 in Atlanta, Georgia. ACEP Board member John Rogers, MD, FACEP testified on behalf of ACEP that “emergency physicians share the vision and the promise that EHRs provide. We do not select the EHR or pay for it, the hospital does, but we pay for it in other ways: lost productivity, workflow interruptions, usability frustrations. That is our investment and we deserve a return on that investment. And the number one thing we ask is sharing that information. Patient information cannot be held hostage to serve the proprietary interests of the vendors. When the information is liberated good things happen.”

    Congressional Hearings
    7/22--House Veterans’ Affairs Committee held a hearing to receive the Secretary’s testimony regarding the Pending VA Health Care Budget Shortfall and System Shutdown; a list of witnesses can be found here.

    7/22--House Veterans' Affairs Health Subcommittee marked-up of pending legislation, including HR 3016 — VA Provider Equity Act and HR 3106 — A bill to authorize Department major medical facility construction projects for fiscal year 2015, to amend title 38, United States Code, to make certain improvements in the administration of Department medical facility construction projects, and for other purposes. Additional details on the mark-up can be found here.
      
    7/22--House Ways and Means Health Subcommittee held a hearing with MedPAC to discuss hospital payment issues, rural health issues, and beneficiary access to care. A list of witnesses can be found here.

    7/22--Senate Special Aging Committee held a hearing titled, " The Doctor's Not In: Combating Medicare Provider Enrollment Fraud;" a list of witnesses can be found here.

    7/23--House Energy and Commerce Health Subcommittee: markup of H.R. 1344, the Early Hearing Detection and Intervention Act, H.R. 1462, the Protecting Our Infants Act, H.R. 1725, the National All Schedules Prescription Electronic Reporting Reauthorization Act (NASPER), and H.R. 2820, the Stem Cell Therapeutic and Research Reauthorization Act. Further details can be found here.

    Upcoming Congressional Hearings
    7/28 -- House Ways and Means Health Subcommittee scheduled hearing to discuss rural health care disparities created by Medicare regulations. Additional details can be found here.

    EMTALA Liability Bill Continues to Gain Support
    ACEP's top legislative priority, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) continues to garner Congressional support. Since the last update, seven Members of Congress have been added as co-sponsors to H.R. 836. The most recent additions include: Reps. Mike Bishop (R-MI), Mike Fitzpatrick (R-PA), Bill Shuster (R-PA), Kathleen Rice (D-NY), Evan Jenkins (R-WV) and Cathy McMorris Rodgers (R-WA). Since the introduction of the bills in February of this year, the legislation has garnered 78 co-sponsors in the House and 6 co-sponsors in the Senate.

    Host and ED Visit for Your Member of Congress
    It is ACEP's goal, with your help, to continue to strengthen ties with member of Congress both in Washington DC and back home in congressional districts. Over the upcoming August congressional recess, we are scheduling ED tours and meetings for legislators, hosted by ACEP 911 Network members, to help them understand the challenges faced by emergency physicians on a day-to-day basis when delivering care to thousands of patients - their constituents. Our goal is to schedule at least one visit per week throughout the country.

    Please contact Jeanne Slade if you are interested in hosting an ED visit or meeting in the district during the upcoming August congressional recess.

    "Triple E Campaign" - How You Can Help
    ACEP, under the leadership of Dr. Andy Bern, recently launched the "Triple E Campaign: to Expand – Enhance – Engage" the 911 Legislative Grassroots Network. More information can be found in a recent article in the online version of ACEPNow. To help your ACEP state chapter earn points toward the contest that culminates at ACEP15 in Boston, please consider recruiting an ACEP colleague to join the Network on the ACEP Grassroots Advocacy Center here.

  • Weekly Update, July 17, 2015

    The Senate and House of Representatives will be in session next week. Debate continues through the month on must-do items including the President’s Iran nuclear deal and a long-term highway funding bill.

    ACEP/SAEM Ask Congress to Restore AHRQ Funding
    ACEP President Michael Gerardi, MD, FACEP and SAEM President Deborah Diercks, MD jointly sent a letter to congressional leaders this week to request their help in restoring FY 2016 funding for the Agency for Healthcare Research and Quality (AHRQ).

    The letter pointed out, among other things, the important work conducted by the Patient-Centered Outcomes Research Institute (PCORI), which is crucial to the development of efficacious quality measures for emergency physicians and other health care providers.

    A copy of the letter is available here.

    New Kaiser Study Examines Medicare and Medicaid at 50 Year Mark
    An overwhelming majority of Americans want Medicare to stay pretty much as is, though a smaller majority is worried that the program needs changes to stay solvent, according to a recent Kaiser Family Foundation poll in honor of Medicare’s upcoming 50th anniversary. One change Congress could make draws big, bipartisan support: allowing the government to negotiate prices with drug companies. Expanding premiums for wealthier beneficiaries also is backed by a majority of the public, as are some cuts to Medicare Advantage plans. There's much less support for raising the eligibility age or for turning the program into a block grant or massively overhauling it, the poll shows. Medicaid isn't quite as well loved, but the findings do indicate its impressively broad reach — nearly two-thirds of respondents said they had a personal connection to Medicaid, either because they were covered or close family or friends were.

    Some insured Americans report difficulty getting their health insurance to pay for care, finding a provider willing to accept their insurance, or getting a referral or appointment to see a specialist. Those with Medicaid are more likely to say they’ve had each of these problems than those with Medicare or employer-sponsored coverage. Nearly a quarter (23 percent) of those with Medicaid report trouble finding a health care provider willing to accept their insurance, compared to about one in ten among those with employer-sponsored insurance or Medicare (9 percent each). The full report is available here.

    Telemedicine Licensing Bill Introduced
    The TELE-MED Act (H.R.3081) was reintroduced this week by Reps. Devin Nunes (R-CA) and Frank Pallone (D-NJ). A Senate version was introduced Hawaii Sen. Mazie Hirono. The bill would allow doctors licensed in one state to treat Medicare patients in any other state without going before additional licensing boards. Despite its backing from pro-telemedicine groups it is strongly opposed by the AMA and Federation of State Medical Boards.

    ACEP Members Host ED Visits
    It is ACEP's goal, with your help, to continue to strengthen ties with member of Congress both in Washington DC and back home in congressional districts. Over the upcoming August congressional recess, we are scheduling ED tours and meetings for legislators, hosted by ACEP 911 Network members, to help them understand the challenges faced by emergency physicians on a day-to-day basis when delivering care to thousands of patients - their constituents. Our goal is to schedule at least one visit per week throughout the country.

    This week, Dr. Hijinio Carreon hosted Rep. David Young (R-IA) in the Emergency Department at Mercy Medical Center in Des Moines, Iowa. Dr. Hijinio invited Rep. Young to tour this ED while meeting with the Congressman in his Capitol Hill office during ACEP’s Lobby Day in May.

    Please contact Jeanne Slade if you are interested in hosting an ED visit or meeting in the district during the upcoming August congressional recess.

    "Triple E Campaign" - How You Can Help
    ACEP, under the leadership of Dr. Andy Bern, recently launched the "Triple E Campaign: to Expand – Enhance – Engage" the 911 Legislative Grassroots Network. More information can be found in a recent article in the online version of ACEPNow. To help your ACEP state chapter earn points toward the contest that culminates at ACEP15 in Boston, please consider recruiting an ACEP colleague to join the Network on the ACEP Grassroots Advocacy Center here
  • Weekly Update, July 13, 2015

    Dr. Heck Announces Bid for U.S. Senate
    On July 6, ACEP Member Dr. Joe Heck (R-NV), entered the race for the U.S. Senate seat being vacated by Democrat Harry Reid. He made the announcement in an online video on his campaign website that emphasized his family's immigrant story, his career as an emergency physician and his military experience. Dr. Heck served as a state senator between 2004 and 2008 and has been the U.S. Representative for Nevada's Third District since 2010. He also has spent more than two decades as an Army reservist, including three active-duty tours and a deployment in Iraq. He's also the only one-star general in Congress.

    Dr. Heck will likely face Reid's hand-picked successor, former state Attorney General Catherine Cortez Masto, in the general election.

    House Approves Biomedical Reform Bill
    On Friday, the House of Representatives overwhelmingly approved H.R. 6, the "21st Century Cures Act," by a vote of 344 to 77. The bill is designed to streamline the approval process for medical treatments, drugs and devices. It provides nearly $9 billion for NIH, and $550 million for FDA, in mandatory funding over five years to incentivize biomedical research. Approval of the bill in the House caps an 18-month effort by House Energy and Commerce Committee Chairman Fred Upton (R-MI) and lead Democrat Diana DeGette (D-CO).

    The Senate HELP Committee has been developing a companion bill based on its "Innovation for Healthier Americans" report released in January. However, committee chairman Lamar Alexander (R-TN) has indicated his committee will focus on several education measures before turning to the biomedical bill and it is likely that the committee will not have a bill ready for the full Senate's consideration until 2016.

    Slavitt Nominated for Permanent CMS Post
    On Thursday, President Obama nominated Andy Slavitt to be the permanent CMS administrator, a position he has held on an acting basis since his appointment in January. However, there have been concerns raised prior to his Senate Finance Committee confirmation hearing about his past role as a United Health Group executive and the role United Health has played in the Affordable Care Act's implementation, especially in the insurance exchange marketplaces. Furthermore, some have questioned the decision by the Obama Administration to provide Slavitt with a waiver exempting him from the president's executive order on ethics in government as well as the judgment that allowed him to keep nearly $5 million in health industry stock (including some from United Heath Group) after he was hired at CMS.

    As acting CMS head, Slavitt manages 165,000 employees who oversee implementation of the Affordable Care Act, Medicare, Medicaid and CHIP, in addition to benefit outlays in excess of $1 trillion annually.

    EMTALA Liability Bill Continues to Gain Support
    ACEP's top legislative priority, the "Health Care Safety Net Enhancement Act" (H.R. 836/S. 884) continues to gain momentum. Since the last update, Reps. David Scott (D-GA), Lynn Jenkins (R-KS), Bob Dold (R-IL), Tom Rooney (R-FL), Greg Walden (R-OR) and Mac Thornberry (R-TX) have been added as co-sponsors to H.R. 836; and Sen. John Hoeven (R-ND) has been added as a co-sponsor to S. 884.

    ACEP Members Host ED Visits
    It's ACEP's goal, with your help, to continue to strengthen ties with each member of Congress over the upcoming August congressional recess. We are scheduling ED tours and meetings between Congress and ACEP 911 Network members to help them understand what emergency physicians face on a day-to-day basis and how you serve their constituents. These meetings are often the start to a mutually beneficial relationship founded on trust, good information, and community ties.

    Thank you to the following ACEP members who have taken time to conduct these tours recently:

    • Dr. Kathleen Cowling for Congressman John Moolenaar (R-MI) at Covenant-Harrison Medical Center
    • Dr. Peter Jacoby for Senator Richard Blumenthal (D-CT) at Saint Mary's Hospital
    • Dr. Jaime Rivas for Congressman Scott Peters (D-CA) at Pomerado Hospital
    • Dr. Theodore Ziff for Congressman Glenn Thompson (R-PA) at Mt. Nittany Medical Center

        

    Please contact Jeanne Slade if you are interested in hosting an ED visit or meeting in the district during the upcoming August congressional recess.

    "Triple E Campaign" - How You Can Help
    ACEP, under the leadership of Dr. Andy Bern, recently launched the "Triple E Campaign: Expand – Enhance – Engage" for the 911 Legislative Grassroots Network. To help your Chapter earn points in time for ACEP15 in Boston, consider recruiting a colleague to sign-up on the ACEP Grassroots Advocacy Center here.

  • Weekly Update, June 26, 2015

    Congressional Schedule
    The Senate and House of Representatives are in recess for the July 4th holiday and will return on Monday, July 7.

    King v. Burwell Decision
    On Thursday, in a 6-3 decision, the U.S. Supreme Court upheld the Affordable Care Act's subsidies for individuals who obtain their insurance through federal (not state) exchanges. Challengers to the law argued that the federal government should not be allowed to continue doling out subsidies to individuals living in the 34 states operating a federal exchange and a ruling in their favor would have ended subsidies for more than 6 million Americans. The focus of the case revolved around the interpretation of four words in the ACA text - "established by the state." In the majority decision, Chief Justice John Roberts acknowledged that the contentious phrase was ambiguous, but that its meaning in the context of the law as a whole was clear. Republicans in Congress have vowed to continue fighting "Obamacare," but acknowledge that their best chance to repeal the law in the short-term has passed.

    Click here to read ACEP's press release.

    House Approves IPAB Repeal Legislation
    The House of Representatives voted 244-54 on Tuesday to abolish the Independent Payment Advisory Board (IPAB). The Board was created under the ACA and is tasked to make cuts to Medicare if spending rises above a certain level. Twenty Democrats joined with Republicans to co-sponsor the IPAB repeal bill, introduced by Rep. Phil Roe (R-TN), but only 11 voted to repeal it because of objections to the offset, which cuts $8.25 billion from an ACA preventive health fund.

    ACEP opposes the creation of the IPAB. If realized, IPAB will have 15 full-time members, appointed by the president and confirmed by the Senate, who, once approved, will have no accountability to Congress, health care providers or the public. Only a minority of the commissioners can be health care providers and none of them may be practicing physicians. IPAB decisions on how to implement Medicare cuts would force Congress to adopt the recommendations or find comparable savings and, without congressional action, the cuts will automatically be implemented by Health and Human Services (HHS).

    Hospitals and nursing homes (Medicare part A) are not subject to IPAB’s cost-cutting recommendations until fiscal year 2020; therefore, its spending reductions could be primarily focused on Medicare part B services, potentially reducing physician payments.

    The White House has threatened to veto the bill if it reaches the President’s desk.

    House and Senate Appropriations Committees Pass HHS Spending Bills
    This week, both the House and Senate Appropriations Committees passed their versions of spending bills to fund the U.S. Departments of Labor, Health and Human Services, and Education. As reported last week, the House Appropriations Committee’s version approved $153 billion in spending by a party-line vote of 30 to 21. Their bill would boost NIH funding by $1.1 billion dollars and contains additional increases for the CDC and other initiatives. But the measure would eliminate the Agency for Healthcare Research and Quality and includes provisions that would end funding for ACA implementation and other program management at CMS.

    The Senate version of the bill, like the House, eliminates funding for the ACA. Furthermore, the Senate proposal would eliminate funding for IPAB. Other highlights include:

    • Department of Health and Human Services (HHS) - $70.4 billion (-$646 million)

    • National Institutes of Health (NIH) - $32 billion (+$2 billion)

    • Fighting Opioid Abuse - $67 million (+$35 million)

    • Community Health Centers - $1.7 billion (+$200 million)

    • Rural Health Care - $150.6 million (+$3.1 million)

    • Children’s Hospitals Graduate Medical Education (CHGME) - $270 million (+$5 million)

    • Mental Health Block Grants - $482.6 million (level funding)

    No further action will happen on either bill until the House and Senate return after their July 4th recess. However, ACEP is developing a letter in conjunction with the Society of Academic Emergency Medicine that will share our support and concerns about various program funding levels with the House and Senate.

    Rural Emergency Acute Care Hospital Act Introduced
    An ACEP-supported bill introduced Tuesday, the "Rural Emergency Acute Care Hospital (REACH) Act" (S. 1648), by Sens. Chuck Grassley (R-IA) and Cory Gardner (R-CO) would help rural Critical Access Hospitals convert to a newly created category for "Rural Emergency Hospitals" (REHs). These hospitals would have the option to become a REH if they eliminate all inpatient services, maintain 24-hour emergency medical care, and observation that doesn't exceed 24 hours (or one midnight), among other things. The Medicare payment structure for REHs would be 105% of reasonable costs, as opposed to the 101% of reasonable costs for CAHs.

    In addition, ACEP worked closely with Sen. Grassley’s office to insert language that would expand the Public Health Service Corps loan forgiveness program to emergency physicians who work at an REH and remove the current financial disincentive for emergency medicine residents to do rotations at rural hospitals.

    Emergency Psychiatric Care Bill Advances out of Committee
    The Senate Finance Committee held a bipartisan executive session on Wednesday to mark-up several miscellaneous health care bills. All twelve bills considered were passed by voice vote and positively reported out of the committee. Of particular interest to ACEP is the legislation that pertains to emergency psychiatric care introduced by Sens. Ben Cardin (D-MD), Pat Toomey (R-PA), Debbie Stabenow (D-MI) and Sherrod Brown (D-OH). The "Improving Access to Emergency Psychiatric Care Act of 2015" (S. 599) would extend the length of the emergency psychiatric demonstration project (established in the ACA) through fiscal year 2016. In addition, the demonstration project may be continued through 2019, and possibly expanded to more states, if certain fiscal criteria are met.

    For further details on the twelve bills reported out of committee, please click here.

    ACEP Comments on Chronic Care
    On Monday, ACEP submitted comments to the Senate Finance Committee’s Chronic Care Working Group. The Committee solicited comments to work toward addressing aggregate costs and finding solutions for the staggering incidence of chronic disease in America with emphasis on our nation’s elderly population. To read the letter, please click here.

    Congressional Hearings
    On Wednesday, the House Ways and Means Oversight Subcommittee held a hearing on rising health insurance premiums under the ACA. During the hearing, it was noted that in order to keep costs down, ACA-compliant plans have relied on narrower provider networks, meaning fewer doctors and limited availability. Also, much of the law's new health insurance "coverage" came in the form of expanding Medicaid. Since many individuals can't get in to see their doctors, and many more doctors aren't taking Medicaid patients, the ACA is actually driving the number of emergency department visits up, which is the opposite of what proponents of the law said would be achieved. For more information on the hearing, click here.

    Also on Wednesday, the House Energy and Commerce Health Subcommittee held a hearing titled “Examining the Administration's Approval of Medicaid Demonstration Projects;” further details from the hearing can be found here.

    President Obama Meets the Ruiz Family

    President Obama met ACEP Member and Congressman Raul Ruiz's (D-CA-36) newest additions, twin girls Sage and Sky, over Father's Day weekend at Palm Springs International Airport. Read the story here.

    Have you taken a look at the new ACEP Grassroots Advocacy Center?
    We have combined all the information you need to become a successful advocate for emergency medicine in one place including:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab

    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill

    • Information on all of ACEP’s “Key Issues” in Congress

    • Tips for Hosting an Emergency Department Visit for your legislator.

    You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.

  • Weekly Update, June 19, 2015

    House Repeals Medical Device Tax

    The House of Representatives voted Thursday to abolish a tax on medical device makers as a group of Democrats uncharacteristically joined Republicans in moving to repeal part of President Barack Obama's health care law.  The President has stated he will veto this legislation.

    Thursday's 280-140 House vote was exactly the two-thirds margin that supporters would need to override a presidential veto. The real suspense will come in the Senate, which voted overwhelmingly to repeal the tax in 2013, but in a non-binding roll call.

    The Republican-led House has voted more than 50 times since 2011 to void all or part of the Affordable Care Act (ACA), usually along party lines. On Thursday, Republicans were joined by 46 Democrats from states where medical devices are made to erase the 2.3 percent tax.

    The tax on medical devices took effect two years ago and was designed to help pay for the health care overhaul. It is imposed on equipment like artificial hearts and X-ray machines, but not items used by individuals like eyeglasses, wheelchairs or blood glucose monitors.

    The House was also expected to take up repeal of the Independent Payment Advisory Board (IPAB) this week but pushed the vote to Tuesday so they could complete action on the trade bill


    Speaking of the ACA…

    The vote came as Congress prepares for an imminent Supreme Court decision in King vs. Burwell, a case that challenges whether an estimated 6.4 million Americans in more than 30 states can legally obtain Obamacare insurance subsidies from the federal government.

    Check the SCOTUS Blog for the latest information.

    Republican leaders in the House and Senate promised to have a plan if the court rules against the Obama administration. On Wednesday, the first details of these proposals were unveiled. A plan proposed by Sen. Ron Johnson (R-WI) would extend the subsidies for up to two years in exchange for repeal of the individual and employer mandate. Sen. John Barrasso (R-WY), a physician, has been tasked by the Republican leadership to lead the replacement effort in the Senate, where intentions are less clear at this point.

    One House proposal (from Ways and Means Committee Chairman Paul Ryan, Energy and Commerce Committee Chairman Fred Upton and Education and the Workforce Committee Chairman John Kline) would allocate block grants to the states that want them so that they could determine how to best spend the money to cover consumers. States that don't want the block grants would be able to keep the subsidies offered under ACA. The Ryan-Upton-Kline plan would give block grants to the states that are affected for the next two years, with the idea that a new Republican president could enact an ACA alternative. This proposal would also repeal the individual and employer mandates and would sunset the entire ACA sometime in 2017. A more conservative alternative has been offered by Rep. Paul Gosar (R-AZ). The Gosar bill would end the ACA's subsidies and eliminate the law's age rating restrictions, benefit mandates and minimum actuarial value requirement.


    House Subcommittee Approves FY 16 Funding for Labor-HHS-Education

    On Wednesday, the House Appropriations Labor-HHS-Education Subcommittee marked-up the fiscal year 2016 funding bill. Overall, the bill provides $153 billion in discretionary funding ($3.7 billion less than in FY 15) and not only defunds existing ACA programs, but prohibits any new discretionary funding from being used to further implement the ACA, including the elimination of the Agency for Health Research and Quality (AHRQ). Other bill features include:

    • Department of Health and Human Services (HHS) - $71.3 billion (+ $298 million)
      • Health Resources and Services Administration (HRSA) - $6 billion (- $299 million)
        • Community Health Centers - $1.5 billion (same)
        • Children's Hospital GME - $265 million (same)
    • Centers for Disease Control and Prevention (CDC) - $7 billion (+ $140 million)
      • Programs to combat prescription drug abuse - $70 million (+ $50 million)
      • Public Health Preparedness and Response - $1.56 billion (+ $108 million)
    • National Institutes of Health (NIH) - $31.2 billion (+ $1.1 billion)
    • Substance Abuse and Mental Health Services Administration (SAMHSA) - $3.6 billion (+ $1.8 billion)
      • Substance Abuse Block Grant - $1.8 billion (same)
      • Services to address prescription drug abuse and heroin use in high-risk communities - $45 million (+ $13.1 million)

    The full House Appropriations Committee is scheduled to consider the bill on Wednesday.


    EMTALA Liability Bill Continues to Gain Bi-Partisan Support

    The most recent co-sponsors to H.R. 836, the "Health Care Safety Net Enhancement Act," include Reps. Rick Allen (R-GA), Elise Stefanik (R-NY), Dennis Ross (R-FL), Jason Smith (R-MO), Leonard Lance (R-NJ), Markwayne Mullin (R-OK), Katherine Clark (D-MA) and Steve Israel (D-NY). H.R. 836 now has 64 co-sponsors and the Senate companion bill (S. 884) has five co-sponsors.


    Congressional Hearings

    6/16 - House Energy and Commerce Health Subcommittee: hearing on H.R. 2646, the "Helping Families in Mental Health Crisis Act."

    Upcoming:

    6/24 – House Energy and Commerce Health Subcommittee: hearing titled “Examining the Administration’s-Approval of Medicaid Demonstration Projects;” 10:00 a.m., 2123 Rayburn Bldg.

    6/24 – House Ways and Means Oversight Subcommittee: hearing on rising health insurance premiums under Obamacare; 10:00 a.m., 1100 Longworth Bldg.


    Have you taken a look at the new
    ACEP Grassroots Advocacy Center?

    We have combined all the information you need to become a successful advocate for emergency medicine in one place including:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab
    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill
    • Information on all of ACEP’s “Key Issues” in Congress
    • Tips for Hosting an Emergency Department Visit for your legislator.

    You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.


    Physician Specialty Candidate Workshop, July 10-11 in Washington DC

    More than ever before, we need the expertise and leadership of emergency physicians like you in city halls, statehouses and Congress.  If you have been thinking about taking your advocacy to the next level, this program is not to be missed. 

    ACEP has teamed up with other physician specialty groups including Ob-Gyns, Radiologists, Dentists, and Anesthesiologists to host the Specialty Physician and Dentist Candidate Workshop, specifically designed for physicians, to provide you with the tools you need to run a successful campaign for local, state or federal office.  The program includes everything you need to know about winning an election including:

    • Hiring a campaign team
    • Building a campaign plan
    • Polling
    • Media and fundraising strategies.

     Click these links for the agenda, registration form, and hotel information. Please email Jeanne Slade with questions or for additional information. 

  • Weekly Update, June 15, 2015

    House Committee to Discuss Mental Health Legislation
    On Tuesday, the House Energy and Commerce Health Subcommittee will hold a legislative hearing to discuss two mental health proposals. The first bill, sponsored by Rep. Tim Murphy (R-PA), the “Helping Families in Mental Health Crisis Act of 2015” (H.R. 2646), would provide additional resources and comprehensive reforms to improve care for patients with mental health disorders. This ACEP-supported legislation would, among other things:

    • Improve research, data collection and efficacy of existing mental health programs, including the prevalence of emergency department boarding of psychiatric patients;
    • Promote evidence-based medicine to create systems of care for patients with mental illness;
    • Encourage early intervention and prevention programs;
    • Increase access and availability of community mental health programs;
    • Remove regulations that currently prohibit the same-day billing under Medicaid for treatment of physical and mental health for the same patient, in the same location, on the same day;
    • Expand the availability of inpatient psychiatric beds by amending the Medicaid Institutes for Mental Disease (IMD) exclusion to give states the option of receiving federal matching payments for care of adult patients with mental illness on a short-term basis;
    • Allow physicians to share limited information with the caregiver of a person with mental illness to help support the patient and their treatment; and

    Establish federal liability protections for health professionals who volunteer at community health centers or behavioral health centers.

    To read ACEP’s support letter for H.R. 2646, click here.

    The other bill under consideration, H.R. 2690, “Including Families in Mental Health Recovery Act of 2015,” sponsored by Rep. Doris Matsui (D-CA), would essentially codify 2014 guidance from HHS’ Office of Civil Rights on when health care providers and other HIPAA-covered entities may disclose health information on mental health patients.

    House Committee Discusses ACA and HHS
    Last Wednesday, the House Ways and Means Committee held a hearing on the implementation of the ACA and the FY 2016 budget for HHS. HHS Secretary Sylvia Burwell was the only witness. To read more about the hearing, click here.

    House Begins HHS Appropriations Process
    On Wednesday, the House Labor-HHS-Education Appropriations Subcommittee will mark-up its version of the fiscal year 2016 spending plan for those federal departments. In addition to the programs ACEP traditionally supports, such as Emergency Medical Services for Children (EMSC), Traumatic Brain Injury (TBI) and Hospital Preparedness, we have specifically been working this year with House and Senate appropriators on language to support the NIH Office of Emergency Care Research (OECR).

    Have you taken a look at the new ACEP Grassroots Advocacy Center?
    We have combined all the information you need to become a successful advocate for emergency medicine in one place including:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab
    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill
    • Information on all of ACEP’s “Key Issues” in Congress
    • Tips for Hosting an Emergency Department Visit for your legislator.

    You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.

    Physician Specialty Candidate Workshop, July 10-11 in Washington DC
    More than ever before, we need the expertise and leadership of emergency physicians like you in city halls, statehouses and Congress. If you have been thinking about taking your advocacy to the next level, this program is not to be missed.

    ACEP has teamed up with other physician specialty groups including Ob-Gyns, Radiologists, Dentists, and Anesthesiologists to host the Specialty Physician and Dentist Candidate Workshop, specifically designed for physicians, to provide you with the tools you need to run a successful campaign for local, state or federal office.

    The program includes everything you need to know about winning an election including:

    • Hiring a campaign team
    • Building a campaign plan
    • Polling
    • Media and fundraising strategies.

    Just confirmed: ACEP member Dr. Dan Morhaim, a member of the Maryland House of Delegates since 1994, will be a featured speaker on the program.

    Click these links for the agenda, registration form, and hotel information. Please email Jeanne Slade with questions or for additional information.

  • Weekly Update, June 5, 2015

    House Committee Approves IPAB Repeal Legislation
    The House Ways and Means Committee on Tuesday approved 10 healthcare related bills, including legislation that would repeal two provisions of the Affordable Care Act (ACA). Those bills would repeal the medical device tax and the cost-cutting panel known as the Independent Payment Advisory Board (IPAB) and they are tentatively scheduled to be considered on the House floor in a couple of weeks. The device tax repeal (H.R.160) passed the Ways and Means Committee on a mostly party-line vote.

    However, seven Democrats (Reps. John Lewis (D-GA), Richie Neal (D-MA), Mike Thompson (D-CA), John Larson (D-CT), Bill Pascrell (D-NJ), Danny Davis (D-IL), and Linda Sanchez (D-CA)) joined all Republicans in voting to repeal the IPAB (H.R.1190). The eight Democrats who opposed H.R.1190 were Reps. Sander Levin (D-MI), Charlie Rangel (D-NY), Jim McDermott (D-WA), Xavier Becerra (D-CA), Lloyd Doggett (D-TX), Earl Blumenauer (D-OR), Ron Kind (D-WI) and Joe Crowley (D-NY).

    The IPAB repeal legislation is estimated to cost roughly $7 billion (over 10 years), but it does not include an off-set and that could make progress through Congress more difficult. During the debate, some Democrats noted that the IPAB is basically irrelevant, as it does not yet exist, and said other cost-control items, like the move to payments based on quality instead of quantity, mattered more.

    EMTALA Liability Bill Continues to Gain Support
    ACEP's top legislative priority, the "Health Care Safety Net Enhancement Act" (H.R.836/S.884) continues to gain momentum. Since the last update on May 15, Reps. Erik Paulsen (R-MN), Pat Tiberi (R-OH), Ann Wagner (R-MO), Keith Rothfus (R-PA), Steve Stivers (R-OH) and Candice Miller (R-MI) have been added as co-sponsors to H.R.836; and Sens. Bill Cassidy (R-LA) and Deb Fischer (R-NE) have co-sponsored S.884.

    Dr. Heck Requests GAO Study on ED Utilization
    On May 21, emergency physician and Member of Congress, Dr. Joe Heck (R-NV), sent a letter to the U.S. Government Accountability Office (GAO) requesting they conduct a study on the impact the Affordable Care Act has had "on the utilization and availability of emergency department services." Dr. Heck cited the recent ACEP survey that found ED visits continued to climb in the second year of the ACA, in contradiction to many predictions.

    He also cited the December HHS Inspector General's report that found more than half of providers listed in Medicaid managed-care plans didn't have appointments available and for those providers who could offer an appointment, the median wait time was two weeks, but more than a quarter of physicians had wait times of more than a month. To read Dr. Heck's letter to GAO Comptroller General Gene Dodaro, please click here.

    Mental Health Bill Introduced in the House
    On Thursday, Rep. Tim Murphy (R-PA) reintroduced a new version of the “Helping Families in Mental Crisis” legislation he created in response to the Newtown, Conn. school shootings in 2012. Rep. Murphy has moderated some of the provisions relating to court-ordered treatment, patient privacy and protection and advocacy programs to assuage critics of the previous version and to generate more bi-partisan support for a vehicle that could move through Congress.

    The bill contains new language on early intervention and prevention, expanding the mental health workforce and ensuring insurance coverage of behavioral health care. It would expand meaningful use payments to psychiatric hospitals, psychologists, community health centers and substance abuse facilities that invest in EHRs.

    Rep. Eddie Bernice Johnson (D-TX) is the Democratic sponsor and the legislation has 18 original co-sponsors, 12 Republicans and eight Democrats.

    Mental health reform and psychiatric patient boarding in emergency departments were key issues discussed by ACEP members during the Capitol Hill visits on May 5 in conjunction with the Legislative Advocacy Conference in Washington DC.

    ACEP will be reviewing the legislation over the next week and will have a more in-depth analysis available in the next Weekly Update.

    We expect Sens. Chris Murphy (D-CT) and Reps. Bill Cassidy (R-LA) will be introducing their version of mental health legislation in the Senate in the near future.

    Safe Harbor Liability Bills Introduced
    On Tuesday, Rep. Andy Barr (R-KY) and Sen. John Barrasso (R-WY) introduced the ACEP-supported "Saving Lives, Saving Costs Act" (H.R. 2603/S. 1475). The legislation would allow physicians who can demonstrate they followed recommended best practices developed by the physician community to benefit from increased liability protection in the form of a legal safe harbor. The safe harbor would allow physicians the right of removal to federal court and of alternative dispute resolution with an independent review panel of experts. If the panel finds the defendant was compliant with the standard of care, the plaintiff would be required to meet a heightened burden of proof (if the plaintiff decides to proceed with the case).

    ACEP has endorsed the legislation and has been a supporter since the bill was originally introduced in 2011.

    Have you taken a look at the new ACEP Grassroots Advocacy Center?
    We have combined all the information you need to become a successful advocate for emergency medicine in one place including:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab
    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill
    • Information on all of ACEP’s “Key Issues” in Congress

    Tips for Hosting an Emergency Department Visit for your legislator.
    You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.

    Physician Specialty Candidate Workshop, July 10-11 in Washington DC
    More than ever before, we need the expertise and leadership of emergency physicians like you in city halls, statehouses and Congress. If you have been thinking about taking your advocacy to the next level, this program is not to be missed.

    ACEP has teamed up with other physician specialty groups including Ob-Gyns, Radiologists, Dentists, and Anesthesiologists to host the Specialty Physician and Dentist Candidate Workshop, specifically designed for physicians, to provide you with the tools you need to run a successful campaign for local, state or federal office.

    The program includes everything you need to know about winning an election including:

    • Hiring a campaign team
    • Building a campaign plan
    • Polling
    • Media and fundraising strategies.

    Just confirmed: ACEP member Dr. Dan Morhaim, a member of the Maryland House of Delegates since 1994, will be a featured speaker on the program.

    Click these links for the agenda, registration form, and hotel information. Please email Jeanne Slade with questions or for additional information.

    CMS Releases Year 2 (2013 data) on its Physician Compare Website
    This year’s release separates drug costs from physician claims – an issue last year for certain specialties that administer large amounts of expensive drugs, e.g. oncologists. Since payments are all predetermined fee schedule amounts, the only thing that may be of interest are variations in charges for emergency department E/M services.

    More Flexible Shared Saving ACO Regulation Finalized
    After criticism from groups that need more time to fully implement ACOs, CMS agreed to allow a second three-year contract period before imposing downside risk.

    A third option called “Track 3” will be a hybrid of the Pioneer (risk bearing) ACO and the Shared Savings model which is strictly fee for service and beneficiaries can seek care outside the ACO.

    The Track 3 model will provide a waiver to the three-day stay rule. A summary of the rule provides more information and a link to the full text.

  • Weekly Update, May 28, 2015

    Since Congress is in recess the week for the Memorial Day Holiday, we will take the opportunity this week to bring you up to speed on several regulatory items.

    CMS Releases a Long-Awaited Medicaid Plan Revision Draft Reg
    This proposed rule is the first Medicaid managed care update since 2002. CMS actuaries reported that total Medicaid outlays at more than $431 billion for FY 2012 before the expansion. This draft rule largely addresses the need to align Medicaid MCO rules with Qualified Health Plans available through exchanges and Medicare Advantage plans. Provisions include: 1) Emergency services must be paid for whether or not the provider is in or out of the network and payment can’t be denied on the basis of diagnoses or symptoms; 2) MCOs could impose certain limits based on “medical necessity” which could be a significant concern for us; 3) The rule also seeks to establish a medical loss ratio of 85% - which plans and states are already protesting, and four states will monitor network adequacy using “reasonable access” standards. As we know, enforcement is almost always the weak link with Medicaid because there are 50+ individual programs. We will be submitting formal comments by the July 27, 2015 deadline. This notice is scheduled to be published in the Federal Register the first week of June at which time the FR version and pdf will be posted to the CMS website.

    CMS to Release Open Payments (Sunshine Rule) Physician Data for Year 2 in June, 2015
    CMS plans to publish the 2014 payment data and make any applicable updates to the 2013 data during June 2015. More information about the Open Payments is available at: www.cms.gov/openpayments. This public database was created last year pursuant to an ACA mandate to report gifts, speaking fees, meals, travel, etc. of over a $10 value that manufacturers provide to physicians and hospitals. The website to verify what is being reported in your name has been widely criticized by physicians as having a cumbersome and intrusive physician registration process. If you have had trouble registering or viewing your information, contact Barbara Tomar in the ACEP Washington DC office at btomar@acep.org.

    Pre-Hospital Care Bill Introduced in House
    On May 15, Rep. Larry Bucshon (R-IN) reintroduced the “Field EMS Modernization and Innovation Act” (H.R.2366) to make improvements in pre-hospital services. H.R.2366 would create a temporary program to evaluate alternative disposition and reimbursement models; enhance physician medical oversight; start a ground ambulance quality incentive payment program; provide grants to help pre-hospital services prepare for natural or man-made disasters, as well as for workforce development purposes; establish a new Office of Emergency Medical Care; clarify the role of the Secretary of Health and Human Services (HHS) as the lead on all federal public health and medical response; and promote EMS research, among other things.

    ACEP has endorsed the legislation and has been a supporter since the bill was originally introduced in 2011.

    Have you taken a look at the new ACEP Grassroots Advocacy Center?

    We have combined all the information you need to become a successful advocate for emergency medicine in one place including:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab
    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill
    • Information on all of ACEP’s “Key Issues” in Congress

    Tips for Hosting an Emergency Department Visit for your legislator.
    You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.

    Physician Specialty Candidate Workshop, July 10-11 in Washington DC
    More than ever before, we need the expertise and leadership of emergency physicians like you in city halls, statehouses and Congress. If you have been thinking about taking your advocacy to the next level, this program is not to be missed.

    ACEP has teamed up with other physician specialty groups including Ob-Gyns, Radiologists, Dentists, and Anesthesiologists to host the Specialty Physician and Dentist Candidate Workshop, specifically designed for physicians, to provide you with the tools you need to run a successful campaign for local, state or federal office. The program includes everything you need to know about winning an election including:

    • Hiring a campaign team
    • Building a campaign plan
    • Polling
    • Media and fundraising strategies.

    Just confirmed: ACEP member Dr. Dan Morhaim, a member of the Maryland House of Delegates since 1994, will be a featured speaker on the program.

    Click these links for the agenda, registration form, and hotel information. Please email Jeanne Slade with questions or for additional information.

  • Weekly Update, May 22, 2015

    Congress will be in recess for the Memorial Day Holiday and will return to business on June 1.

    21st Century Cures Legislation
    The House Energy and Commerce Committee unanimously approved the “21st Century Cures Act” on Thursday. The bill was introduced by Chairman Fred Upton (R-MI), Diana DeGette (D-CO), Health Subcommittee Chairman Joe Pitts (R-PA), full committee Ranking Member Frank Pallone (D-NJ), and Health Subcommittee Ranking Member Gene Green (D-TX).

    The legislation is designed to speed the discovery, development and delivery of new medical treatments to patients by streamlining clinical research and creating more flexible medical device and drug approval pathways for industry.

    The bill also delineates and confines FDA regulation of health IT and software, strives to achieve the interoperability of electronic records and mandates studies on telemedicine by CMS and MedPAC.

    A manager's amendment released earlier in the day included around $13 billion in offsets and laid out a Cures Innovation fund to provide $550 million in new mandatory funding for FDA.

    The offsets include cutting the amount of time that private Medicare Part D drug plans receive reinsurance funds from the government before the money is spent on medical care. Funds typically go out at the beginning of the month and are held for 46 days on average, accruing interest for insurance companies instead of the government.

    The other major offset will come from selling oil from the Strategic Petroleum Reserve that would bring in $5.2 billion over 10 years, according to CBO. Other items include: limiting the federal Medicaid match for durable medical equipment to Medicare rates ($2.8 billion) and instituting payment penalties for the use of outdated X-ray technology ($200 million).

    Other House committees, including Ways & Means, are expected to get a 30-day referral on the legislation. Chairman Upton plans a floor vote in June. The Senate HELP Committee is moving at a much slower pace on a similar biomedical reform effort and doesn’t plan to have a bill until early next year.

    ACEP continues to review the legislation and monitor its progress through Congress.

    Veterans Emergency Care Bills Introduced in Senate
    This morning, Sen. Mazie Hirono (D-HI) introduced two ACEP-supported bills to help improve veterans’ access to emergency medical care. The “Veterans Emergency Health Safety Net Expansion Act of 2015” would eliminate the requirement that a veteran must have received care at a VA facility within the previous 24 months in order to be eligible for reimbursement of emergency care by non-VA provider. The “Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act” would promote the recruitment and retention of emergency physicians and hospitalists in the VHA system by allowing more flexibility for their irregular work schedules.

    Senate Hearing on Hospital Observation Stays
    On Wednesday, the Senate Special Aging Committee held a hearing titled "Challenging the Status Quo: Solutions to the Hospital Observation Stay Crisis.”

    ACEP actively supports the “Improving Access to Medicare Coverage Act of 2015 (S.843/ H.R.1571),” bi-partisan bi-cameral legislation that seeks to address the hospital observation stay issue. The Senate version was introduced by Sens. Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL), and Shelley Moore Capito (R-WV), and the House companion bill was introduced by Reps. Joe Courtney (D-CT) and Joe Heck (R-NV).

    Currently, unless a patient spends at least three consecutive days in the hospital as an inpatient, Medicare Part A will not pay for post-hospital nursing care and rehabilitation in a skilled nursing facility (SNF), forcing the patient to pay thousands of dollars in out-of-pocket costs or go without needed care. This legislation would count all of a patient’s time in the hospital in observation toward the three-day inpatient hospital stay requirement under the Medicare statute for coverage of SNF care. Medicare statute's definition of "post-hospital extended care services" would be amended to clarify that Medicare beneficiaries in observation are deemed inpatients during this time. This change will help ensure that Medicare beneficiaries receive the SNF coverage they need under Medicare Part A. Additional details on the hearing can be found here.

    Activity on Opioid Abuse Epidemic
    The latest in a series of hearings on opioid abuse conducted by the House Energy and Commerce Subcommittee on Oversight and Investigations was held on Thursday, focusing on how state governments are handling the opioid epidemic. Additional details on the hearing can be found here.

    Also this week, Senate Majority Leader Mitch McConnell (R-KY) and Sen. Ed Markey (D-MA) wrote a letter to Health and Human Services Secretary Sylvia Mathews Burwell encouraging her to call on the surgeon general to issue a report and call to action on opioid abuse, and to seek clarification on HHS’ opioid abuse initiative announced in March. The goals of the initiative are to provide training and resources to health professionals to aid them in making prescription decisions, increase the use of naloxone, and expand the use of medication-assisted treatment, combining medicine with counseling and behavioral therapies to address substance abuse.

    Have you taken a look at the new ACEP Grassroots Advocacy Center?
    We have combined all the information you need to become a successful advocate for emergency medicine in one place. You will find:

    • Information on your own legislators including committee assignments under the “Find your Legislator” tab
    • “Take Action” option where you can email your legislators about important issues like the EMTALA Liability Bill. An editable letter is available on the site which you can email directly to your legislators to ask for their support and co-sponsorship
    • Information on all of ACEP’s “Key Issues” in Congress
    • Tips for Hosting an Emergency Department Visit for your legislator

    You will need your ACEP log-in credentials to access the ACEP Grassroots Advocacy Website. Take a look today and share with your ACEP colleagues.

    Physician Specialty Candidate Workshop, July 10-11 in Washington DC
    More than ever before, we need the expertise and leadership of emergency physicians like you in city halls, statehouses and Congress. If you have been thinking about taking your advocacy to the next level, this program is not to be missed. ACEP has teamed up with other physician specialty groups including Ob-Gyns, Radiologists, Dentists, and Anesthesiologists to host the Specialty Physician and Dentist Candidate Workshop, specifically designed for physicians, to provide you with the tools you need to run a successful campaign for local, state or federal office. The program includes everything you need to know about winning an election including:

    • Hiring a campaign team
    • Building a campaign plan
    • Polling
    • Media and fundraising strategies.

    Click these links for the agenda, registration form, and hotel information. Please email Jeanne Slade with questions or for additional information.

  • Weekly Update, May 15, 2015

    Congress will be in session until May 22 when they will break for the Memorial Day Holiday, returning June 1.

    Congress Approves Budget Deal for Fiscal Year 2016

    Last Tuesday, the Senate passed the final budget resolution, by a vote of 51 to 48, which upholds the statutory sequestration caps on discretionary spending ($494 billion for non-defense programs) in FY2016, reduces overall spending by $5 trillion over the next 10 years, and gives Congress the authority to use the reconciliation process to repeal the Affordable Care Act. Reconciliation allows legislation to be approved in the Senate by a simple majority vote and is protected from a filibuster, which would require 60 votes to proceed. The House approved the resolution on April 30 by a vote of 226 to 197.

    The tax and spending levels set forth in the budget resolution clear the way for House and Senate Appropriations Committee members to produce the 12 annual spending measures to fund federal agencies and programs. However, many Democrats have expressed concern that the reconciliation discretionary spending limit on non-defense programs is too low and does not provide enough funding for other domestic programs. This could lead to problems, especially in the Senate, gaining enough support to approve the individual appropriations bills.

    IPAB Repeal Gains Momentum

    More than 500 organizations, including ACEP and 26 of its chapters, wrote to Congress this month urging lawmakers to eliminate the Independent Payment Advisory Board (IPAB) that was established by the Affordable Care Act as a mechanism to control Medicare spending. IPAB is charged with making cuts to Medicare should the program exceed a certain threshold and is required to achieve the allotted savings within a one-year timeframe, which would make the use of long-term structural improvements to the Medicare program’s efficiency difficult and make payments cuts to providers fare more likely. Additionally, after being nominated by the president and confirmed by the Senate, IPAB members would have no real accountability to Congress, providers or the public when making their decisions about where to make Medicare cuts.

    ACEP is advocating for the enactment of IPAB repeal legislation, the “Protecting Seniors’ Access to Medicare Act of 2015” (H.R.1190/S.141), which currently has 229 co-sponsors in the House and 39 co-sponsors in the Senate.

    21st Century Cures Legislation

    The House Energy and Commerce Health Subcommittee approved the latest draft of the “21st Century Cures Act” on Thursday by voice vote. The bill was introduced by full committee Chairman Fred Upton (R-MI), Diana DeGette (D-CO), Health Subcommittee Chairman Joe Pitts (R-PA), full committee Ranking Member Frank Pallone (D-NJ), and Health Subcommittee Ranking Member Gene Green (D-TX).

    The legislation’s primary focus is on accelerating the drug and medical device development process in order to expedite patient access, but the legislation does also address issues related to medical research, electronic health record interoperability, telemedicine, Medicare site-of-service transparency and pharmacy/provider lock for Medicare Part D prescriptions. The full committee is expected to consider the bill next week.

    ACEP is currently reviewing the legislation.

    Additional Co-Sponsors added to EMTALA Liability Bill

    ACEP priority legislation (H.R.836/S.884) that seeks liability protections for federally-mandated care provided by emergency and on-call physicians has been re-introduced in both the House by Rep. Charlie Dent (R-PA) and in the Senate by Sen. Roy Blunt (R-MO). The legislation was one of the top issues discussed at the Capitol Hill Visits during the LACLS 2015. Thus far the legislative proposal has garnered the support of 50 co-sponsors in the House and 4 co-sponsors in the Senate. Recent co-sponsors of H.R.836 include Reps. Brian Babin (R-TX), Brett Guthrie (R-KY) and Mimi Walters (R-CA). Senator Dean Heller (R-NV) recently signed on to the Senate version.

    If your legislators are not yet co-sponsors, please contact them through our ACEP Grassroots Advocacy Center. An editable letter is available on the site which you can email directly to your legislators to ask for their support and co-sponsorship of the EMTALA liability legislation. You will need your ACEP log in credentials to access the ACEP Grassroots Advocacy Website. Please Take Action today.
  • LACLS Edition, May 15, 2015

    ACEP 2015 “Lobby Day” Brings Record Number of Emergency Physicians to Capitol Hill

    On Tuesday, May 12, 456 emergency physicians and residents visited with federal legislators and staff on Capitol Hill in conjunction with the ACEP 2015 Legislative Advocacy Conference and Leadership Summit (LACLS) in Washington, D.C. Overall, ACEP members from 46 states and the District of Columbia participated in 384 meetings in Capitol Hill offices with legislators and/or their health care staff. Ninety-two percent of the Senate offices were visited while 67 percent of the House of Representatives’ offices were visited. Visit our ACEP Advocacy Facebook page to see ACEP members in action on Capitol Hill!

    The Hill visits focused on three specific legislative “asks” and provided the opportunity for the physicians to discuss the findings of a new poll of ACEP members that tracked changes in emergency department patient volume and care since January 1, 2014, when the requirement to have health care took effect in the Affordable Care Act (ACA). Three-quarters of the ACEP members reported that emergency visits are going up, representing a significant increase from just one year ago when less than half reported increases.

    More than one-quarter (28 percent) report significant increases in all emergency patients since the requirement to have health insurance took effect. In addition, more than half (56 percent) say the number of Medicaid patients is increasing.

    While on Capitol Hill, the physicians:

    • Expressed a big “Thank You” to the Representatives and Senators who voted to repeal the flawed Sustainable Growth Rate (SGR) formula used to reimburse physicians for their Medicare services. Congress overwhelmingly approved legislation to repeal the SGR and replace it with a system that rewards quality, efficiency and innovation. The House passed the bill, H.R. 2, the "Medicare Access and CHIP Reauthorization Act" (MACRA), on March 26 by a vote of 392-37, the Senate approved the bill on April 14 by a vote of 92-8 and President Obama signed it into law on April 16 (P.L.114-10).
    • Asked legislators to “Co-Sponsor” the "Health Care Safety Net Enhancement Act of 2015" (H.R.836/S.884), sponsored by Representative Charlie Dent (R-PA) and Senator Roy Blunt (R-MO). The bill provides medical liability relief for physicians providing care under the EMTALA mandate.
    • Asked legislators to “Consider and Support” legislative efforts to provide resources for patients with mental illness and stop the practice of boarding psychiatric patients in the Emergency Department. ACEP anticipates legislation will soon be reintroduced in the House by Representatives Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX), as well as introduced in the Senate by Senators Chris Murphy (D-CT) and Bill Cassidy (R-LA). ACEP endorsed Rep. Murphy’s mental health bill (H.R.3717) in the previous Congress.
    • Sen. Cassidy gave the keynote address to the LACLS attendees on May 4 at which time he asked for ACEP members’ support of the pending legislation noting that emergency physicians are on the front lines of the mental health crisis. Sen. Cassidy also announced during the lunch that he would be a co-sponsor of S.884.

    Additional issues discussed were funding for emergency medicine and trauma including specific support for the mission of the NIH Office of Emergency Care Research (OECR) and fully funding emergency regionalization, trauma systems and trauma center grants.

    The physicians also discussed graduate medical education funding as new GME bills were introduced just days before the conference in the House and Senate.

    Senators Bill Nelson (D-FL), Charles Schumer (D-NY) and Senate Minority Leader Harry Reid (D-NV), introduced the “Resident Physician Shortage Reduction Act of 2015” (S.1148) Reps. Joe Crowley (D-NY) and Charles Boustany (R-LA) introduced the House companion legislation (H.R. 2124) on the same day. ACEP is currently reviewing the bills.

    The background materials and handouts that helped prepare the physicians for their visits are available on the ACEP Advocacy website. You will need your ACEP credentials to log-in.

    If you participated in the congressional meetings last week, but have not yet submitted your feedback forms, please complete the Visit Report and scan/email to Gabrielle Szlenkier or fax to 202-728-0617 so that we may provide any needed follow-up with these Members of Congress.

    You can claim your CME credit using ACEP's CME Tracker

    As a reminder, if you shot video on your cell phone during visit to Capitol Hill and would like to share it with us -- please upload it to http://j.mp/1b4CECQ. The password is lacls2015. Questions? Contact Mike Baldyga at ACEP’s Public Relations Office at mbaldyga@acep.org or 202-370-9288.

    Unable to attend the LACLS Conference this year?
    You can participate in our “Virtual Lobby Day” by sending an email to your legislators asking for their support and co-sponsorship of the EMTALA liability legislation. Please go to the ACEP Grassroots Advocacy Website to Take Action today.

    And finally, make sure you mark your calendars for next year's Legislative Advocacy Conference and Leadership Summit, May 15-18, 2016 in Washington DC.

    Strong Support of NEMPAC during Conference
    Nearly $100,000 was collected in conjunction with the LAC meeting toward the NEMPAC annual campaign goal of $1 million. ACEP President Mike Gerardi, MD, FACEP, recognized Dr. Vidor Friedman during the meeting for his leadership in encouraging his partners at Florida Emergency Physicians to donate a total of $49,300 (40 Give a Shift Donations) to the 2015 campaign.

    NEMPAC also hosted six fundraising dinners for Members of Congress during the LACLS meeting. Seventy ACEP leaders, NEMPAC Board members and conference attendees participated in the dinners adding their personal donations to NEMPAC contributions for the following legislators’ election campaigns: Sens. Bill Cassidy (R-LA), Chris Murphy (D-CT) Mark Kirk (R-IL), Shelley Moore Capito (R-WV), Ron Wyden (D-OR) and Rep. Dutch Ruppersberger (D-MD).

  • Weekly Update, May 1, 2015


    ACEP Lobby Day Next Week


    Hundreds of ACEP Members will visit Capitol Hill on May 5 in conjunction with the 2015 Legislative Advocacy Conference and Leadership Summit (LACLS)

    We hope to see you in Washington, D.C. next week for the 2015 Legislative Advocacy Conference and Leadership Summit. Monday’s sessions will feature speakers including physician and U.S. Senator Bill Cassidy (R-LA), Jeremy Brown, MD from the Office of Emergency Care Research at NIH, Daniel Green, Medical Officer for Clinical Standards and Quality at CMS, and Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform.

    After an Advocacy Training and Issues Briefing Session, attendees will spend the afternoon of Tuesday, May 5 on Capitol Hill meeting with legislators and their staff. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    If you are interested in learning about the legislative issues that will be discussed on the Hill Visits, please click here and scroll down to the Legislative Issues Papers.

    NEW THIS YEAR AT LACLS: Congressional Dine-Arounds Sponsored by the National Emergency Medicine PAC (NEMPAC)
    Don’t miss this one of a kind opportunity to discuss the hot button issues pending in Congress and share the views of emergency medicine with key decision makers. Events are scheduled with the following legislators:

    Monday, May 4
    Rep. Dutch Ruppersberger (D-MD) – Cocktail Reception, 6:30 pm, Cuba Libre, 801 9th Street, NW ($100 suggested donation)
    Senator Bill Cassidy (R-LA) – Dinner, 6:30 pm, Ruth’s Chris Steak, 724 9th Street, NW ($200 suggested donation)
    Senator Chris Murphy (D-CT) – Dinner, 6:30 pm, 701 Restaurant, 701 Pennsylvania Ave., NW ($200 suggested donation)
    Senator Ron Wyden (D-OR) – Dinner, 6:30 pm, Bistro Cacao Restaurant, ($250 suggested donation)

    Tuesday, May 5
    Senator Shelley Moore Capito (R-WV) – Dinner, 6:30 pm, NOPA Kitchen and Bar, 800 F Street, NW ($200 suggested donation)
    Senator Mark Kirk (R-IL) – Dinner, 6:30 pm, Capitol Hill Club, 300 First Street, SE ($200 suggested donation)

    For more information or to sign up for an event, contact ACEP Political Affairs Director Jeanne Slade.

    If you are unable to attend the conference this year, we will be providing instructions on how to participate in an ACEP “Virtual Hill Day.” You can send a message to your federal legislators to coincide with ACEP’s Lobby Day on May 5 on Capitol Hill to amplify the voice of emergency medicine on important health policy issues.

    FY 16 Budget Agreement Approved by House

    Yesterday, the House approved the final version of the fiscal year 2016 budget resolution (S.Con.Res. 11) by a vote of 226 to 197. Representatives from the House and Senate budget committees have been working to reconcile the differences between their two proposals for the past few weeks. The resolution balances the federal budget within 10 years and provides procedural protections for Senate Republicans to repeal the Affordable Care Act. The resolution also cuts discretionary non-defense funding by nearly $500 billion, Medicare by $431 billion and Medicaid by roughly $500 billion over the next decade.

    While the budget resolution does not have the force of law, it does guide spending allocations for the annual congressional appropriations process.

    The Senate is expected to consider the final budget resolution next week.

    House Approves First FY 16 Appropriations Bills

    The House began consideration of the first two (of 12) annual appropriations bills this week. The Fiscal Year 2016 Military Construction/Veterans Affairs Appropriations bill was approved yesterday by a vote of 255 to 163. The Fiscal Year 2016 Energy and Water Appropriations bill was approved early this morning by a vote of 240 to 177. The House Appropriations Committee also cleared the way for consideration of the Fiscal Year 2016 Legislative Branch Appropriations bill yesterday.

    President Obama has stated he will veto any appropriations bills that adhere to the lower spending (sequestration) levels agreed to in the Budget Control Act of 2011. Many House Democrats are opposing the appropriations measures with the hope that it will force Republicans to reconsider the discretionary spending caps they have placed on the annual funding bills.

    New Draft of 21st Century Cures Bill Released

    On Wednesday, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and senior committee member Diana DeGette (D-CO) unveiled the latest draft of legislation, 21st Century Cures, proposing changes to the drug development and delivery process. The legislation would increase funding for NIH, modernize clinical trial search capabilities, require the FDA to establish a framework to assess patient experience data in regulatory decision making, and establish a priority review program for certain breakthrough medical devices and technologies.

    Two sections of the bill regarding telemedicine and data registries are of particular interest to ACEP. However, those provisions are still being developed by lawmakers and revised language has not yet been made available.

    ACEP will continue to work with members of the Energy and Commerce Committee to include proposals that would promote reimbursement for telemedicine services, provide additional clarification and support for medical specialty data registries (such as ACEP’s Clinical Emergency Data Registry), and enhance emergency medicine research activities within the NIH.

    GME Bills Introduced

    On Thursday, April 30th, Senators Bill Nelson (D-FL), Charles Schumer (D-NY) and Senate Minority Leader Harry Reid (D-NV), introduced the “Resident Physician Shortage Reduction Act of 2015” (S. 1148) Reps. Joe Crowley (D-NY) and Charles Boustany (R-LA) introduced the House companion legislation (H.R. 2124) on the same day. ACEP is reviewing the bills but according to statements by the AAMC, the bills are identical to legislation introduced in the 113th Congress (H.R.1180/S.577) with one inclusion; language giving preference to hospitals affiliated with VA medical centers. The broader GME transparency and accountability GME bill is now being championed in the House by Rep. Kathy Castor (D-FL). The Congresswoman is still looking for a lead Republican to help re-introduce the bill, which is expected to be introduced prior to the Memorial Day recess. At this time, that bill does not have a Senate counterpart.

    Senate Finance Hearing on Audit and Appeals Issues in Medicare

    On Thursday, the Senate Committee on Finance held a hearing titled, “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.” You can view a brief synopsis of the hearing here. In December 2014, ACEP, in conjunction with EDPMA sent a letter to CMS Administrator Marilyn Tavener regarding the appeal backlog. To view the letter, please click here.

    The House will be in recess next week and will return on May 12. The Senate will be in session.
  • Weekly Update, April 24, 2015


    White House Rose Garden Reception to Celebrate Passage of SGR Repeal

    ACEP’s Executive Director, Dean Wilkerson, along with members of Congress and representatives of other medical specialties were invited to The White House Rose Garden on Tuesday for an event celebrating the recent passage and signing into law of the Medicare “Doc Fix.” Here is a short video highlighting that visit on ACEP’s YouTube page. Further details on the new SGR repeal law can be found at www.acep.org.

    2015 Legislative Advocacy Conference and Leadership Summit (LACLS) – Now is the Time!
    After years of working to repeal the flawed SGR formula, it is clear that building relationships and voicing the concerns of emergency physicians and patients to Congress are more important than ever in getting positive results for the future of the specialty.

    Please plan to join hundreds of your ACEP colleagues in Washington, D.C. from May 3-6 at the 2015 Legislative Advocacy Conference and Leadership Summit. You will spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Additional information and registration details for the LACLS are available on the ACEP Website.

    NEW THIS YEAR AT LACLS 2015

    Congressional Dine-Arounds Sponsored by the National Emergency Medicine PAC (NEMPAC)

    Join your emergency physician colleagues and some of the nation’s most influential lawmakers while dining at the best restaurants in Washington DC. A minimum donation to the Member of Congress’ campaign is suggested for participation (see below), which will be added to the support provided by NEMPAC. Don’t miss this one of a kind opportunity to discuss the hot button issues pending in Congress and share the views of emergency medicine with key decision makers. Events are scheduled with the following legislators:

    Monday, May 4
    Rep. Dutch Ruppersberger (D-MD) – Cocktail Reception, 6:30 pm, Cuba Libre – 801 9th Street, NW ($100 suggested donation)
    Check made payable to: Dutch Ruppersberger for Congress

    Senator Bill Cassidy (R-LA) – Dinner, 6:30 pm, Ruth’s Chris Steak, 724 9th Street, NW ($200 suggested donation)
    Check made payable to: Continuing America’s Strength and Security PAC (CASS PAC)

    Senator Chris Murphy (D-CT) – 6:30 pm, Location TBD ($200 suggested donation)
    Check made payable to: Friends of Chris Murphy

    Senator Ron Wyden (D-OR) – Dinner, ($250 suggested donation)
    Check made payable to: Wyden for Senate

    Tuesday, May 5
    Senator Shelley Moore Capito (R-WV) – Dinner, 6:30 pm, NOPA Kitchen and Bar, 800 F Street, NW ($200 suggested donation)
    Check made payable to: Wild and Wonderful PAC

    Senator Mark Kirk (R-IL) –Dinner, 6:30 pm, Capitol Hill Club, 300 First Street, SE, ($200 suggested donation)
    Check made payable to: Kirk for Senate

    For more information or to sign up for an event, contact ACEP Political Affairs Director Jeanne Slade.

    Additional Co-Sponsors added to EMTALA Liability Bill
    ACEP priority legislation (H.R.836/S.884) that seeks liability protections for federally-mandated care provided by emergency and on-call physicians has been re-introduced in both the House by Rep. Charlie Dent (R-PA) and in the Senate by Sen. Roy Blunt (R-MO). The legislation has garnered the support of 47 co-sponsors in the House and 3 co-sponsors in the Senate thus far. Recent co-sponsors of H.R.836 include: Reps. Billy Long (R-MO) and Rodney Davis (R-IL).
    The legislation will be one of the top issues discussed at the Capitol Hill Visits during the LACLS.

    Controversial Human Trafficking Legislation Clears the Senate
    The Senate on Wednesday passed legislation aimed at curbing human trafficking, ending a month-long fight that bitterly divided the parties and held up Attorney General Nominee Loretta Lynch. The legislation, which was approved 99-0, would create a special fund to help victims of sex crimes, bolstering efforts to combat what advocates decry as “modern-day slavery.” But it was the bill’s controversial language on abortion that received much of the attention and created a battle on the Senate floor that began in March. Democrats repeatedly blocked an earlier version of the proposal, arguing it would create an expansion of the Hyde Amendment, which restricts the use of federal funds for abortions. The deal that resolved the stalemate requires money for the victims’ fund to come from two sources: criminal fines and money that Congress previously appropriated.

    Surgeon General Sworn-In
    Vivek Murthy was officially sworn in as the 19th Surgeon General this week. Murthy outlined three major goals for his tenure as the nation’s doctor: combat misinformation, shift the culture of health from treatment to prevention, and eliminate damaging behaviors like smoking that are entrenched in our society.

    House Passes Drug Abuse Bill
    The House on Tuesday approved by voice vote the “Ensuring Patient Access and Effective Drug Enforcement Act,”H.R.471, a bipartisan bill aimed at decreasing prescription drug abuse. It directs HHS, DEA and the Office of National Drug Control Policy (ONDCP) to coordinate their work on curbing drug abuse while still ensuring legitimate patient access to controlled substances. Similar Senate legislation, S.483, has been introduced by Sens. Orrin Hatch (R-UT) and Sheldon Whitehouse (D-RI.)

    Telehealth Hearing in the Senate
    On Tuesday, the Senate Commerce, Science & Transportation Subcommittee on Communications, Technology, Innovation and the Internet held a hearing about the expansion of telehealth services. Witnesses told lawmakers that telehealth is helping achieve financial and care-related benefits, but that barriers remain to widespread use. However, they also pointed out several challenges preventing further use of telehealth services, including: the Federal Communications Commission (FCC), the lack of interstate licensing, poor broadband connectivity, and provider reimbursements. Many of the lawmakers said that Medicare should reimburse for telehealth services. At this time it is unclear if telehealth provisions will be included in the Energy and Commerce Committee’s, “21st Century Cures,” legislative package. This Committee will hold a hearing on the “21st Century Cures” bill next week. It is also expected that several telehealth related bills will be introduced in Congress again this year. For further details on the Senate telehealth hearing, please click here.

    Senate EHR Working Group
    This week, Senate HELP Committee Chair Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) formed a bipartisan working group to review the status of Electronic Health Records (EHRs). The working group will provide recommendations for administrative and legislative improvements and is scheduled to begin meeting later this month.

    Upcoming Congressional Hearings
    4/28 – Senate Committee on Finance to hold a hearing titled, “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare;” further details here.

    4/28 – Senate Health, Education, Labor and Pensions Committee: hearing titled "Continuing America's Leadership: The Future of Medical Innovation for Patients;” a list of witnesses can be found here.

    4/30 – House Veterans' Affairs Committee: hearing titled "Examining Access and Quality of Care and Services for Women Veterans;” further details can be found here.

    4/30 – House Energy and Commerce Subcommittee on Health will hold a “Legislative Hearing on 21st Century Cures;” more information can be found here.
  • Weekly Update, April 17, 2015


    President Obama Signs SGR Repeal Legislation Flawed SGR Formula Finally Eliminated

    For 13 years, ACEP along with the American Medical Association and other physician organizations have been urging Congress to repeal the fundamentally flawed Sustainable Growth Rate (SGR) formula used to reimburse physicians for their Medicare services. After numerous "Calls for Action," Leadership and Advocacy Conference meetings, ED visits, in-District meetings, calls, advocacy efforts by the Public Affairs staff in D.C., and 17 temporary patches to avert physician payment cuts, the U.S. Congress overwhelmingly approved legislation to repeal the SGR and replace it with a system that rewards quality, efficiency and innovation. The House passed the bill, H.R. 2, the "Medicare Access and CHIP Reauthorization Act" (MACRA), on March 26 by a vote of 392-37 and the Senate approved the bill on Tuesday night by a vote of 92-8. President Obama signed the bill into law yesterday.

    Prior to the House vote, ACEP and 47 of its chapters joined more than 700 other medical associations signing an AMA-drafted letter urging House Speaker John Boehner to repeal the flawed Medicare physician reimbursement formula. ACEP also conducted a national teleforum conference call with members to brief them on the status of the legislation and encourage them to contact their lawmakers in support of the SGR repeal.

    The Senate voted on six amendments (all of which failed) to modify H.R. 2, including an extension of CHIP funding for an additional two years, requiring the bill’s cost to be fully off-set, and permanently ending the Medicare cap on therapy services, among others. While some of these amendments had merit and were difficult to vote against, ACEP appreciates the Senate’s willingness to work together to defeat these amendments, thereby allowing the bill to be sent to the president for his signature as quickly as possible.

    Key provisions of H.R. 2:
    •Repeals the flawed SGR formula and establishes annual updates of 0.5% from 2015 through 2019;
    •Institutes payment adjustments based on performance in the Merit-Based Incentive Payment System (MIPS) starting in 2019;
    •Assesses MIPS performance of eligible professionals in four categories (quality, resource use, meaningful use and clinical practice);
    •Applies cuts from lower performing providers to pay higher performing providers;
    •Creates optional reimbursement program through participation in Alternative Payment Model (APM) or Patient Centered Medical Home (PCMH);
    •Provides additional financial support to help specialties develop quality measures;
    •Requires Electronic Health Records (EHRs) be interoperable by 2018;
    •Generates a study on how to establish permanent physician-hospital gainsharing program;
    •Produces a GAO report on barriers to expanded use of telemedicine;
    •Extends work Geographic Practice Cost Index (GPCI) floor for two years;
    •Extends add-on payment for ground ambulance services (including super rural) for two years;
    •Permanently extends the Qualifying Individual (QI) program that assists low-income Medicare beneficiaries cover their Part B premium;
    •Delays enforcement of two-midnight policy by Medicare Administrative Contractors (MACs) through September 30, 2015; and
    •Fully funds the Children's Health Insurance Program (CHIP) for an additional two years (through September 30, 2017).

    Click here to read short summaries, or more detailed section-by-section explanations, of the provisions in H.R. 2.

    This is a significant victory for ACEP and organized medicine!

    Sen. Blunt Introduces EMTALA Liability Bill in Senate
    ACEP priority legislation that seeks liability protections for federally-mandated care provided by emergency and on-call physicians is now before both chambers with the introduction S.884, the Senate version of the “Health Care Safety Net Enhancement Act on March 26 by Rep. Roy Blunt (R-MO. Sens. Mark Kirk (R-IL) and Shelly Moore Capito (R-WV) are already on board as co-sponsors. The House version, H.R.836, is up to 45 co-sponsors.

    The most recent co-sponsors are Reps. Diane Black (R-TN), Marsha Blackburn (R-TN), Larry Bucshon (R-IN), Carolos Curbelo (R-FL), Kevin Cramer (R-ND), Jeff Duncan (R-SC), Blake Farenthold (R-TX), Randy Hultgren (R-IL), Bob Latta (R-OH), Mike Pompeo (R-KS),Tom Price (R-GA), John Shimkus (R-IL), and Don Young (R-AK)

    During the upcoming Legislative Advocacy Conference and Leadership Summit, attendees will be meeting with House and Senate members and staff to seek additional co-sponsors for these bills. If you cannot attend the conference, you can go to the www.acepadvocacyACEP Grassroots Advocacy Site to send an email to your legislators to ask for their support of this priority legislation.

    2015 Legislative Advocacy Conference and Leadership Summit (LACLS) – Now is the Time!
    After years of working to repeal the flawed SGR formula, it is clear that building relationships and voicing the concerns of emergency physicians and patients to Congress are more important than ever in getting positive results for the future of the specialty.

    Please plan to join hundreds of your ACEP colleagues in Washington, D.C. from May 3-6 at the 2015 Legislative Advocacy Conference and Leadership Summit. We will spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit.

    Congressional Dine-Arounds Sponsored by the National Emergency Medicine PAC (NEMPAC)
    New this year during LACLS: Join your emergency physician colleagues and some of the nation’s most influential lawmakers while dining at the best restaurants in Washington DC. A minimum donation of $250 to the Member of Congress’ campaign is suggested for participation, which will be added to the support provided by NEMPAC. Don’t miss this one of a kind opportunity to discuss the hot button issues pending in Congress and share the views of emergency medicine with key decision makers. Dinners are scheduled with the following legislators:
    •Senator Shelley Moore Capito (R-WV) – Tuesday, May 5, 6:30 pm, NOPA Kitchen and Bar, 800 F Street, NW
    •Senator Bill Cassidy (R-LA) – Monday, May 4, 6:30 pm, Ruth’s Chris Steak, 724 9th Street, NW
    •Senator Mark Kirk (R-IL) – Tuesday, May 5, 6:30 pm, Capitol Hill Club, 300 First Street, SE
    •Senator Chris Murphy (D-CT) – (Date, time and location TBD)
    •Senator Ron Wyden (D-OR) – Monday, May 4, 6:30 pm, (location TBD)
    •Rep. Dutch Ruppersberger (D-MD) – Monday or Tuesday evening, TBD

    For more information or to sign up for a dinner, contact ACEP Political Affairs Director Jeanne Slade.

    Additional information and registration details for the LACLS are available on the ACEP Website.
  • Weekly Update, March 27, 2015

    House Overwhelmingly Approves SGR Repeal, Senate Delays Action
    For 13 years, ACEP and other physician organizations have been urging Congress to repeal the fundamentally flawed Sustainable Growth Rate (SGR) formula used to reimburse physicians for their Medicare services. After numerous "Action Alerts," Leadership and Advocacy Conference meetings, ED visits, in-district meetings, advocacy efforts by the Public Affairs staff in D.C., coalition meetings, and 17 temporary patches to avert physician payment cuts, the House finally agreed to repeal the SGR and replace it with a system that rewards quality, efficiency and innovation. The overwhelming vote (392 to 37) in favor or H.R. 2, the "Medicare Access and CHIP Reauthorization Act" (MACRA), occurred on Thursday morning. To see how your legislator voted, click here.

    With the House vote approaching, ACEP President Mike Gerardi hosted a special teleforum for ACEP members on Tuesday to provide the latest details about the SGR repeal legislation and its path through Congress. At the end of the call, members were directed to the ACEP Grassroots Advocacy Center and asked to contact their Representative and Senators urging their support for SGR repeal. To hear the recording of the teleforum, click here.

    Last week, ACEP and 47 of its chapters joined more than 700 other medical associations in calling on House Speaker John Boehner to repeal the SGR formula before the current patch expires on March 31 and physicians' Medicare reimbursements would be cut by 21.1 percent.

    Unfortunately, the Senate failed to consider H.R. 2 early Friday morning following a marathon "vote-a-rama" (see story below) on its fiscal year 2016 budget before adjourning for two weeks. CMS has indicated that they will hold claims through April 14 to give Congress time to act. During the discussion about H.R. 2 between Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Harry Reid (D-NV), Reid asked that limited amendments be allowed, including extending CHIP funding for four years, instead of two, and removing the Hyde Amendment language (regarding use of federal funds for abortions) that was included with the extension of Community Health Center funding portion of the bill. McConnell did not agree to that, but said he would work with Reid to get an agreement on the disposition of H.R. 2 immediately when the Senate reconvenes on April 13.

    Key provisions of H.R. 2:
    •Repeals the flawed SGR formula and establishes annual updates of 0.5% from 2015 through 2019;
    •Institutes payment adjustments based on performance in the Merit-Based Incentive Payment System (MIPS) starting in 2019;
    •Assesses MIPS performance of eligible professionals in four categories (quality, resource use, meaningful use and clinical practice);
    •Applies cuts from lower performing providers to pay higher performing providers;
    •Creates optional reimbursement program through participation in Alternative Payment Model (APM) or Patient Centered Medical Home (PCMH);
    •Provides additional financial support to help specialties develop quality measures;
    •Requires Electronic Health Records (EHRs) be interoperable by 2018;
    •Generates a study on how to establish permanent physician-hospital gainsharing program;
    •Produces a GAO report on barriers to expanded use of telemedicine;
    •Extends work Geographic Practice Cost Index (GPCI) floor for two years;
    •Extends add-on payment for ground ambulance services (including super rural) for two years;
    •Permanently extends the Qualifying Individual (QI) program that assists low-income Medicare beneficiaries cover their Part B premium;
    •Delays enforcement of two-midnight policy by Medicare Administrative Contractors (MACs) through September 30, 2015; and
    •Fully funds the Children's Health Insurance Program (CHIP) for an additional two years (through September 30, 2017).

    Click here and check under Breaking News to read short summaries, or more detailed section-by-section explanations, of the provisions in H.R. 2.

    Passage of this legislation would represent a significant victory for ACEP and organized medicine! President Obama has stated his support for the bipartisan bill approved by the House and said he would sign the measure into law if it reaches his desk.

    Please contact your two U.S. Senators to urge them to vote “yes” on MACRA when they return from the spring recess. Please go to the ACEP Grassroots Advocacy Center for instructions on how to send an email or call these offices.

    House and Senate Republicans Approve Prospective Budgets
    On Wednesday, the House of Representatives approved its fiscal year 2016 federal budget plan (H. Con. Res. 27) by a 228 to 199 vote, with 17 Republicans joining all 182 Democrats present to vote against the plan. The vote came after Republican leaders used a rare procedural device to achieve passage.

    The final resolution was amended by the House to raise the limit on war spending to $96 billion and remove the requirement for any of the additional spending to be offset. The FY16 budget plan stays within the discretionary spending caps previously agreed to for next year - $523 billion for defense and $493 billion for non-defense, because the additional money for defense is placed in an "emergency" funding account and does count against the caps.

    Facing a revolt by pro-defense members against the plan approved by the House Budget Committee last week, Republican leaders revived a voting procedure known as "Queen of the Hill." This process allowed the House to consider the original committee plan, the substitute with additional war funding, and four other budget proposals (a more fiscally conservative plan offered by the Republican Study Committee and more liberal plans from the House Democratic Caucus, the Progressive Caucus and the Congressional Black Caucus) and then adopting the one that received the most votes.

    Around 3:30 am this morning, the Senate approved its first budget in two years after voting for 15 hours on more than 40 amendments that ranged from the minimum wage to Iran sanctions to boosting defense spending. Ultimately, Republicans garnered enough votes (everyone except Sens. Ted Cruz (R-TX) and Rand Paul (R-KY)) to pass the Senate's FY16 budget proposal.

    Now that both chambers have approved their respective budget resolutions, the chambers will have to reconcile outstanding differences through a House-Senate conference. If they reach a compromise, it would set overall spending limits for appropriations measures and possibly pave the way for Republicans to repeal the Affordable Care Act with a simple majority vote in the Senate (through a process known as reconciliation). Although President Obama would certainly veto such legislation if it made it to his desk, it would be a vehicle for Members of Congress to register their lingering frustration with the law without having to overcome a Senate filibuster, which requires 60 votes to overcome.

    2015 Legislative Advocacy Conference and Leadership Summit – Now is the Time!
    After years of working to repeal the flawed SGR formula, it is clear that building relationships and voicing the concerns of emergency physicians and patients to Congress are more important than ever in getting positive results for the future of the specialty.

    Please plan to join hundreds of your ACEP colleagues in Washington, D.C. from May 3-6 at the 2015 Legislative Advocacy Conference and Leadership Summit. We will spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Registration is now open, and information and additional details are available on the ACEP Website.

  • ACTION ALERT, March 24, 2015

    SGR REPEAL LEGISLATION GAINING MOMENTUM: CONTACT YOUR LEGISLATORS TO MAKE IT HAPPEN! 

    Congress is closer than ever before in enacting bi-partisan, bi-cameral legislation to replace the Medicare Sustainable Growth Rate (SGR) formula with a payment system that rewards quality, efficiency and innovation (H.R.2/S.810).

    Amplifying emergency physicians’ voice on this issue now is critical.

    The House may take up the legislation as early as Thursday. Senate consideration is expected following the House vote.

    Please take action by sending an email to your federal legislators through the ACEP Grassroots Advocacy Site or www.acepadvocacy.org. You can also call your legislators by telephone via the AMA’s Physicians Grassroots Network hotline at (800) 833-6354.

    The key points to stress with your representative and senators are:
    -For at least 12 years, Congress has recognized the imperative of reforming the Medicare physician payment system. Now that a bipartisan, bicameral policy has been developed, it’s time to stop thinking about the problem and seize the opportunity to solve it.
    -Congress must avoid continuing the fiscally irresponsible cycle of short-term patches that contribute to the Medicare program’s instability and do nothing to solve the underlying problem.
    -Physicians will face about a 21% reduction in Medicare reimbursement rates unless Congress acts by April 1, 2015.
    -Emergency physicians are very concerned that the continued use of the Sustainable Growth Rate (SGR) formula will drive other physicians out of Medicare leaving the emergency department as the only viable alternative for seniors to access the nation's health care system.
    -Furthermore, the U.S. faces a significant expansion of Medicare as 78 million baby boomers begin in the next few years. America's emergency departments already treat more than 136 million patients a year and nearly 18 percent of those visits were by individuals ages 65 and older.

    The $213 billion deal would replace the SGR, as well as provide a two-year extension of the Children's Health Insurance Program. Funding for the package would come in part through $70 billion in spending reductions split between cuts to Medicare benefits and reductions in provider payments.

    Although financing the bill is subject to change, currently about $70 billion of the projected costs are offset. Roughly half of the possible deal's offsets would come from cuts to hospitals, insurers and acute-care providers. The other half of offsets would come from cuts to Medicare beneficiaries, such as additional means testing for high-income beneficiaries. Overall, the deal would be expected to add about $140 billion to the federal deficit over 10 years.

    Please contact Brad Gruehn, ACEP Congressional Affairs Director or Jeanne Slade, NEMPAC and Grassroots Advocacy Director if you have questions or feedback from your communications to Congress.
  • Weekly Update, March 20, 2015

    Bi-Partisan, Bi-Cameral Legislation Introduced to Repeal and Replace the SGR
    ACEP to host special Teleforum to outline details and advocacy action plan (See below)

    On March 19, leaders in the Senate and House introduced bi-partisan legislation to replace the Medicare Sustainable Growth Rate (SGR) formula with a payment system that rewards quality, efficiency and innovation. The deal was negotiated by House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) in recent weeks behind closed doors. But key committee members have signed on as sponsors of the legislation including Rep. Paul Ryan (R-WI), chair of the House Ways and Means Committee and Ranking Member Sandy Levin (D-MI), and Sen. Orrin Hatch (R-UT), chair of the Senate Finance Committee, among others.

    The $213 billion deal would replace the SGR, as well as provide a two-year extension of the Children's Health Insurance Program. Funding for the package would come in part through $70 billion in spending reductions split between cuts to Medicare benefits and reductions in provider payments.

    This SGR replacement measure is largely the same as legislation introduced last year to replace the SGR. While there was bipartisan, bicameral agreement on the legislation last year, both chambers of Congress failed to pass the legislation after lawmakers reached an impasse over how to pay for it. Congress in March 2014 then approved a short-term delay to scheduled reductions to Medicare physician reimbursement rates called for by the SGR, but physicians will face about a 21% reduction in Medicare reimbursement rates unless Congress acts by April 1, 2015.

    Although financing the bill is subject to change, currently about $70 billion of the projected costs are offset. Roughly half of the possible deal's offsets would come from cuts to hospitals, insurers and acute-care providers. The other half of offsets would come from cuts to Medicare beneficiaries, such as additional means testing for high-income beneficiaries. Overall, the deal would be expected to add about $140 billion to the federal deficit over 10 years.

    Specific language to offset the bill's projected costs will be unveiled next week and the entire package is then expected to be voted on next week. The bill language and a timeline are available here on the ACEP Website.

    Legislation Details
    Among other provisions, the SGR replacement legislation would:
    -Provide a 0.5% annual raise through 2019 for providers who participate in Medicare before transitioning to an incentive-based payment system;
    -Encourage providers to participate in alternative payment models focused on patient outcomes, with providers participating qualifying models receiving a 1% annual rate increase beginning in; and
    -Provide $7 billion in funding over two years for community health centers, maintaining the current funding for community health centers that is set to expire on Oct. 1.

    Potential Obstacles
    Early indications are that the proposal is securing broad bipartisan support. However, several potential obstacles remain. Some Senate Democrats, including Senate Minority Leader Harry Reid (D-NV) and Senate Finance Committee Ranking Member Ron Wyden (D-OR) are withholding their support of the bill unless it extends CHIP funding for at least four years, rather than the two-year funding extension currently included in the measure.

    Some Senate Democrats are also concerned about the impact of the pay-fors on seniors and language they believe would codify abortion restrictions. Meanwhile, some conservatives have expressed objections to the SGR replacement deal over how much it would add to the deficit.

    MARK YOUR CALENDARS FOR A SPECIAL ACEP TELEFORUM ON THE SGR REPEAL LEGISLATION

    This legislation has many moving parts and is under a tight schedule for consideration and passage before Congress adjourns at the end of the next week for their Spring Recess – and the latest SGR patch expires on March 31.

    ACEP will be hosting a special teleforum to provide you with more details about the SGR repeal legislation, its path through Congress, and how you can impact the process by contacting your U.S. Senators and Representatives next week.

    The Teleforum, hosted by ACEP President Mike Gerardi, MD, FACEP and ACEP Public Affairs Division staff, is scheduled for Tuesday, March 24 at 4:00 pm ET. You will receive a call at that time to the home telephone that we have on record for you in the ACEP database. You will be prompted to stay on the call and will be have the opportunity to ask questions during the call.

    If you wish to be contacted on another number or if you are unsure if ACEP has your home number in our database, please follow this link to pre-register for the call. http://vekeo.buzz/b0F

    We can call you on a cellular phone if you provide the number on the registration page.

    House Approves Emergency-Trauma Legislation
    On Monday, the House of Representatives overwhelmingly approved two ACEP-supported bills that would improve emergency and trauma care services. The first bill, the “Access to Life-Saving Trauma Care for All Americans Act” (H.R.647), sponsored by Reps. Mike Burgess (R-TX) and Gene Green (D-TX), would reauthorize Trauma Care Center Grants to support their core missions, curtail losses from uncompensated care and provide emergency awards to centers at-risk of closing, as well as Trauma Service Availability Grants to address shortfalls in trauma services, especially in underserved communities. H.R. 647 was approved by a vote of 389 to 10 with the only no votes coming from Reps. Justin Amash (R-MI), Virginia Foxx (R-NC), Tim Huelscamp (R-KS), Walter Jones (R-NC), Doug LaMalfa (R-CA), Tom Massie (R-KY), Tom McClintock (R-CA), Mark Sanford (R-SC), Jim Sensenbrenner (R-WI), and Lynn Westmoreland (R-GA).

    The second bill, the “Trauma Systems and Regionalization of Emergency Care Reauthorization Act” (H.R.648), also sponsored by Reps. Burgess and Green, would reauthorize grants to states for planning, implementing and developing trauma care systems, as well as establish several pilot projects to design, implement and evaluate innovative models of regionalized emergency care. H.R. 648 was approved by a vote of 382 to 15 with no votes coming from Reps. Justin Amash (R-MI), Virginia Foxx (R-NC), Scott Garrett (R-NJ), Tim Huelscamp (R-KS), Duncan Hunter (R-CA), Walter Jones (R-NC), Kenny Marchant (R-TX), Tom Massie (R-KY), Tom McClintock (R-CA), Reid Ribble (R-WI), David Rouzer (R-NC), Mark Sanford (R-SC), Jim Sensenbrenner (R-WI), Lynn Westmoreland (R-GA), and Ted Yoho (R-FL).

    House and Senate Budget Panels Adopt Plans
    The Senate and House Budget Committees advanced their respective and distinct budget proposals this week. Much of the budget debate and discussion in the committees focused on defense spending as well as deficit reduction, repeal of the health care law and tax code overhaul. The version crafted by House Budget Committee Chair Tom Price (R-GA), passed the committee on a 22-13 party-line vote. The Senate version, introduced by Chairman Mike Enzi (R-WY) followed suit with a 12-10 party line vote. Both proposals call for more than $5 trillion in deficit reduction over the next decade, most of which comes from repealing the health care law and savings from Medicare and Medicaid reform. The House and Senate are expected to hold floor votes on their separate budget resolutions by the end of next week. If the non-binding measures can pass muster in each chamber, a conference committee would be established to formalize legislation. Even then a veto threat is expected by the White House.

  • Weekly Update, March 6, 2015

    The House will be in recess next week, while the Senate will be in session. Major budget battles are ahead for Congress. Not only must Congress agree to another patch for Medicare payments to physicians by March 31 (see story below), but leaders also will need to find a way to replenish the rapidly depleting Highway Trust Fund, raise the debt limit and enact next year’s spending bills before Oct. 1.

    Additional Co-sponsors added to EMTALA Liability Bill
    ACEP priority legislation that seeks liability protections for federally-mandated care provided by emergency and on-call physicians was reintroduced in the House earlier this month. The bill, H.R.836, was introduced by Rep. Charlie Dent (R-PA), along with 23 original co-sponsors. So far in this new Congress, the bill has garnered 32 co-sponsors. We expect companion legislation to be introduced in the Senate soon.

    Recent co-sponsors of H.R.836 include: Reps. Mike Burgess (R-TX), Mark Amodei (R-NV), Todd Young (R-IN), Scott DesJarlais (R-TN), and Bill Flores (R-TX).

    ACEP will be sending an action alert in the near future asking you to contact your U.S. Representative to ask for his/her co-sponsorship of this priority legislation.

    2015 Legislative Advocacy Conference and Leadership Summit
    Please save the date of May 3-6, to join hundreds of your ACEP colleagues in Washington DC to hear from congressional leaders and EM experts about the latest legislative and policy initiatives impacting your practice and patients. Spend Tuesday, May 5, on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6, will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Registration is now open, and information and additional details are available on the ACEP Website.

    Congress approves funding for the Department of Homeland Security
    The House voted Tuesday to fund the Department of Homeland Security, ending a months-long impasse over President Obama’s immigration policies and avoiding a shut-down of the agency. A majority of House Republicans opposed the bill with just 75 GOP lawmakers joining with 182 Democrats with a final vote of 257-167. The bill is expected to be signed by the President in the coming days. The legislation did not address immigration executive orders -- a top priority of conservatives. That issue was a sticking point for weeks as Republicans tried to tie DHS funding to the repeal of the orders but the party couldn't overcome Democratic filibusters in the Senate.

    IPAB Repeal Legislation Introduced
    Representatives Phil Roe (R-TN) and Linda Sanchez (D-CA) re-introduced the "Protecting Seniors' Access to Medicare Act" (aka IPAB repeal) this week. The House bill already has 206 House cosponsors. H.R.1190 seeks to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board. The Senate companion bill, S.141, was introduced by Sen. John Cornyn (R-TX) and currently has 37 co-sponsors.

    Medicare Reform and SGR
    House Ways and Means Committee Chair Paul Ryan (R-WI) on Monday said Congress has not yet reached a consensus about how to fund a permanent repeal of Medicare's sustainable growth rate formula (SGR) and will have to pass another short-term fix to prevent a 21% cut scheduled to take effect April 1. ACEP and other physician groups and medical professionals continue to lobby Congress to permanently replace the SGR formula for physician payments prior to the pending expiration date. Rep. Ryan said he supports the bipartisan, bicameral solution proposed last year but the proposal's estimated cost of $174.5 billion over 10 years continues to present hurdles. In addition, Chairman Ryan noted that other fiscal issues on the agenda could lead to a broader fiscal policy discussion or another budget agreement that could help advance SGR discussions later this year.

    King v. Burwell Arguments heard this week by Supreme Court
    On Wednesday, the Supreme Court heard oral arguments in King v. Burwell, which challenges the subsidies to help U.S. residents purchase coverage through the Affordable Care Act's federal exchange.

    At issue in the case is that while the ACA says subsidies are available to help certain U.S. residents purchase coverage offered "through an exchange established by the State," a May 2012 IRS rule allows the subsidies to be used in an exchange administered either by a state or the federal government.

    The plaintiffs argue that the IRS rule should be invalidated because it contradicts what Congress originally wrote in the ACA. Further, the plaintiffs argue that the ACA's subsidies harm them by making them subject to the law's individual mandate and that without the subsidies, they would receive an affordability exemption.

    Meanwhile, the Department of Justice argues that Congress would not have set up such an intricate connection between the law's individual mandate and the subsidies if it intended for the subsidies to not be available in certain states.

    The high court is expected to release a decision in the case by the end of June. If the court strikes down the federal exchange subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis. A complete transcript of the arguments is available here.

    Workforce Study Released
    The U.S. could face a shortage of between 46,000 and 90,000 physicians by 2025, according to a new report from the Association of American Medical Colleges (AAMC.) Based on updated population projections from the U.S. Census Bureau, the estimate is lower than AAMC reported five years ago.

    For the report, researchers used 2013 as a baseline, noting that 767,100 physicians younger than age 75 were practicing. The researchers said that of those physicians, 26% were between ages 55 and 65 and 10% were between ages 65 and 75 (Modern Healthcare, 3/3). Overall, the report found that while the number of physicians is expected to increase, it will not grow quickly enough to meet demand.

    Hearings
    On Thursday, the Senate Health, Education, Labor and Pensions Committee held a hearing titled “America’s Health IT Transformation: Translating the Promise of Electronic Health Records into Better Care;” a list of witnesses can be found here.

    Also on Thursday the House Energy and Commerce Health Subcommittee held a hearing titled “Examining the 340B Drug Pricing Program;” a list of witnesses can be found here.

    Congressional Retirements
    Sen. Barbara A. Mikulski (D-MD) announced Monday she will not seek another term in the Senate. Mikulski, 78, is the longest serving woman in Congress. She has been in the Senate since 1987, after serving 10 years in the House. Her retirement launched a feeding frenzy of candidates eager to run for a rare open Senate seat in Maryland.

    Rep. Candice Miller (R-MI), the only woman to chair a committee in the House, announced Thursday that she will not run for re-election in 2016. She currently is Chair of the Administration Committee and vice chair of the House Homeland Security Committee.
  • Weekly Update, February 27, 2015

    House and Senate Work to Resolve DHS Funding Impasse
    On Friday, the Senate approved, by a vote of 68 to 31, a bill that would provide nearly $40 billion in funding for the Department of Homeland Security (DHS), which would cover the agency's activities for the remainder of fiscal year 2015 (through Sept. 30). This is a "clean" funding bill and does not include any policy riders.
    As of 4:00 pm on Friday, the House was trying to take a different approach and planned to approve a simple three-week funding measure, which House Republican leaders hope would be enough time for the Fifth Circuit Court of Appeals to act on the pending case brought by 26 states that is seeking to stop President Obama's executive actions on immigration. The three-week delay would also provide additional time for the House and Senate to reconcile the differences between the two chambers' DHS funding proposals.
    If the House successfully approves the short-term funding bill, it is expected that the Senate would move quickly to approve that bill in order to avoid a DHS shutdown.
    Current funding for DHS expires tonight without congressional action.

    Additional Co-sponsors Added to EMTALA Liability Bill
    ACEP priority legislation that seeks liability protections for federally-mandated care provided by emergency and on-call physicians was reintroduced in the House earlier this month. The bill, HR.836, was introduced by Rep. Charlie Dent (R-PA), along with 23 original co-sponsors.
    Recent co-sponsors include: Reps. Vern Buchanan (R-FL), Bill Johnson (R-OH), Adam Kinzinger (R-IL), and Rob Wittman (R-VA). To view the legislation and current co-sponsor list, click here.
    We expect companion legislation to be introduced in the Senate soon. To view the press conference, please click here.
    Please be on the lookout for an action alert in the near future asking you to contact your U.S. Representative to ask for his/her co-sponsorship of this important legislation.

    Budget Hearing with Secretary Burwell
    The House Energy and Commerce Health Subcommittee held a hearing Thursday on the president’s fiscal year 2016 budget request for HHS programs. Many items were discussed, but some members used the hearing as an opportunity to press HHS Secretary Sylvia Burwell for details on HHS' plan if federal exchange subsidies are ruled inconsistent with the Affordable Care Act's legislative language by the Supreme Court.
    The subsidies have been challenged in the upcoming Supreme Court case King v. Burwell. The high court will hear oral arguments on Wednesday and will release a decision by the end of June 2015. If the court strikes down the federal exchange subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis. In a recent letter to Congress, Secretary Burwell said the Obama administration has no contingency plan if the high court strikes down the subsidies. In the letter, she wrote that the administration "know[s] of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by" a ruling invalidating the subsidies. To view the hearing, click here.

    Mental Health Debate
    This week Sen. Chris Murphy (D-CT) and Rep. Tim Murphy (R-PA) outlined plans to introduce a pair of mental health reform bills next month. Rep. Murphy, a long-time champion of mental health reform, plans to reintroduce a version of a bill he introduced in the last Congress. Senator Murphy said he would introduce a bill that has "some differences" but is "substantially similar" in the Senate around the same time.
    In addition, both legislators participated in a panel discussion yesterday hosted by The Hill newspaper at the Newseum in Washington, DC. The panel discussed the economic and human consequences of cost-cutting policies that limit access to treatment for individuals with mental health. As state and federal budgets get tighter, spending on mental illness has dramatically fallen -- contributing to significant gaps in America’s mental health safety net. Cash-strapped Medicaid programs bear a large part of the burden of caring for those with mental illness and these programs’ budget troubles are only expected to grow. ACEP’s educational efforts on mental health are ongoing and we will keep you updated on the progress of these legislative proposals. To view portions of the webcast, click here.

    Upcoming Hearings
    On Tuesday, the House Appropriations Labor, HHS, Education Subcommittee will hold a hearing on proposed fiscal 2016 appropriations for the National Institutes of Health. A list of witnesses can be found here.

    On Thursday, the Senate Health, Education, Labor and Pensions Committee will hold a hearing titled “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care.” For more information on the hearing, click here.

    Also on Thursday, the House Energy and Commerce Health Subcommittee will hold a hearing titled “Examining the 340B Drug Pricing Program.” Further details can be found here.

    ED Visits
    The following five 911 Network Members recently hosted Emergency Department visits and meetings on behalf of ACEP for their Members of Congress and their staffs:
    Dr. William Gallea at St. Peter’s Hospital for Jeremy Carpenter, Deputy State Director for new member Rep. Ryan Zinke (R-MT)
    Dr. Matthew Lyon at Regents Medical Center for new member Rep. Rick Allen (R-GA)
    Dr. Daniel Murphy met with new member Rep. Kathleen Rice (D-NY)
    Dr. Rachael Sokol at Unity Point Lutheran Hospital for Sen. Chuck Grassley (R-IA)
    Dr. David Van Ryn at Elkhart Community Hospital for Rep. Jackie Walorski (R-IN)

    Please contact Jeanne Slade in the ACEP's Washington office if you are interested in hosting an ED visit or meeting for your federal legislator.

     2015 Legislative Advocacy Conference and Leadership Summit
    Please save the date of May 3-6 to join hundreds of your ACEP colleagues in Washington DC to hear from congressional leaders and EM experts about the latest legislative and policy initiatives impacting your practice and patients. Spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Registration is now open, and information and additional details are available on the ACEP Website.

  • Weekly Update, February 13, 2015

    Congress will be in recess for the President’s Day work period from Feb. 13 until Feb. 20. Prior to their departure, both chambers passed legislation authorizing construction of the Keystone XL pipeline, but the President is expected to veto this legislation. When they return, Congress will need to immediately deal with legislation to fund the Department of Homeland Security. The temporary funding will expire on Feb. 28.

    EMTALA Liability Bill Reintroduced in House
    ACEP priority legislation that seeks liability protections for federally-mandated care provided by emergency and on-call physicians was reintroduced in the House on Tuesday. The bill, HR.836, was introduced by Rep. Charlie Dent (R-PA), along with 23 other co-sponsors. This legislation is identical to the bill, H.R. 36, which garnered 85 cosponsors in the 113th Congress. We expect companion legislation will be introduced in the Senate soon. To view the press conference and legislation, please click here

    Please be on the lookout for an action alert in the near future asking you to contact your U.S. Representative to ask for his/her co-sponsorship of this important legislation.

    House Committee Approves Emergency-Trauma Legislation
    During a mark-up on Thursday, the full House Energy and Commerce Committee approved several bills addressing public health issues. Two of the bills are of particular interest to ACEP. The “Trauma Systems and Regionalization of Emergency Care Reauthorization Act” (H.R. 648), sponsored by Rep. Mike Burgess (R-TX) and Rep. Gene Green (D-TX), would reauthorize two programs to provide grants to states for planning, implementing and developing trauma care systems, as well as to launch several pilot projects to design, implement and evaluate innovative models of regionalized emergency care and trauma systems.
    The “Access to Life-Saving Trauma Care for All Americans Act” (H.R. 647), also sponsored by Reps. Burgess and Green, would reauthorize Trauma Care Center Grants to support their core missions, curtail losses from uncompensated care and provide emergency awards to centers at-risk of closing, as well as Trauma Service Availability Grants to address shortfalls in trauma services, especially in underserved areas.
    ACEP will continue to work with the sponsors and other interested health care organizations to encourage broad, bipartisan support as the bills move through both the House and Senate in the 114th Congress and, ultimately, their passage into law. To view ACEP's letters of support for H.R. 647 and H.R. 648, click here. To view the mark-up, please click here.

    New Board Member Orientation in Washington DC
    This week, new members of the Board of Directors, Drs. Jon Mark Hirshon and Steve Anderson met in Washington, DC with ACEP and EMRA Board leadership for new board member orientation. Some members met with Members of Congress, others traveled to CMS to discuss ACEP’s mission with Dr. Patrick Conway, CMS Chief Medical Officer, and others attended a medical society roundtable at the White House. ACEP DC staff briefed the board members on the latest regulatory and legislative policies as well as ACEP’s legislative and political goals for this Congress. The board also participated in intensive communication workshops and media training in preparation for becoming ACEP spokespersons.

    House Hearing on Mental Health
    On Wednesday, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing entitled “Federal Efforts on Mental Health: Why Greater HHS [Health and Human Services] Leadership is Needed.” A new report from the nonpartisan Government Accountability Office (GAO) detailing the failures of the federal mental health system was the focus of the hearing. The report was especially critical of the lack of any formal evaluation mechanism for the majority of the programs.
    Dr. Linda Kohn, Director of Health Care at the GAO, and Dr. Richard Frank of the Department of Health and Human Services, accompanied by Pamela Hyde of the Substance Abuse and Mental Health Services Administration, testified on Wednesday. Additional information on Wednesday’s hearing can be found here.

    Senate Hearing on Vaccine-Preventable Diseases
    On Tuesday, the Senate HELP Committee held a hearing entitled “The Reemergence of Vaccine-Preventable Diseases: Exploring the Public Health Successes and Challenges.” A list of witnesses can be found here

    House Hearing on ICD-10
    The House Energy and Commerce Health Subcommittee held a hearing on Wednesday entitled “Examining ICD-10 Implementation.” A list of witnesses can be found here.

    911 Network Advocacy Activities

    ED Visits
    This week, three 911 Network Members hosted Emergency Department visits and meetings on behalf of ACEP for their members of congress or staff.

    Dr. Michael Baker at St. Peter’s Hospital for new member Rep. Debbie Dingell (D-MI) Dr. Cameron Olderog met with new member Rep. Don Beyer (D-VA) in his Capitol Hill office

    Dr. Baruch Fertel at Cleveland Clinic for Beth Thames, District Director for Sen. Sherrod Brown (D-OH)

    Please contact Jeanne Slade in the ACEP Washington DC office if you are interested in hosting an ED visit or meeting for your federal legislator.

    2015 Legislative Advocacy Conference and Leadership Summit
    Please save the date of May 3-6 to join hundreds of your ACEP colleagues in Washington DC to hear from congressional leaders and EM experts about the latest legislative and policy initiatives impacting your practice and patients. Spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit. Registration is now open, and information and additional details are available on the ACEP Website.

  • Weekly Update, February 6, 2015

    Both chambers were in session through Thursday of this week allowing lawmakers a three-day weekend before the House returns to send the Keystone XL pipeline proposal (S 1) off to the president and the Senate tries again to overcome the impasse over Homeland Security funding legislation (HR 240). Both chambers will be back next week then will adjourn for a state or district work period from February 16 -20 over the President’s Day holiday.

    House Health Committee Approves Trauma Legislation
    During a mark-up on Wednesday, the House Energy and Commerce Subcommittee on Health approved four bills addressing public health issues. Two of the bills, which were under consideration during the previous Congress but that were not enacted, are of particular concern to ACEP. The “Trauma Systems and Regionalization of Emergency Care Reauthorization Act,” authored by Rep. Michael Burgess (R-TX) and Rep. Gene Green (D-TX), would reauthorize two programs to provide grants to states for planning, implementing and developing trauma care systems, as well as to launch several pilot projects to design, implement and evaluate innovative models of regionalized emergency care and trauma systems.
    The “Access to Life-Saving Trauma Care for All Americans Act” would reauthorize Trauma Care Center Grants to support their core missions, curtail losses from uncompensated care and provide emergency awards to centers at-risk of closing, as well as Trauma Service Availability Grants to address shortfalls in trauma services, especially in underserved areas.
    ACEP will continue to work with the sponsors and other interested health care organizations to encourage broad, bipartisan support as the bills move through both the House and Senate in the 114th Congress and, ultimately, their passage into law this year. To view the mark-up, please click here.

    President Releases FY 16 Budget
    On February 2, President Obama released his $4 trillion budget proposal for fiscal year 2016. The proposal includes $1.091 trillion in discretionary spending for FY16, which would be $74 billion above the sequestration spending caps that the president wants to eliminate. The additional spending ($38 billion for defense, $37 billion for domestic programs) would produce a $474 billion deficit for next year (about 2.5% of GDP). However, the Obama Administration states the budget would also produce $1.8 trillion in deficit reduction over the next 10 years, including $640 billion in net revenue from capital gains tax increases and other tax changes.
    The proposal includes approximately $400 billion in savings from mandatory health spending programs, such as reducing payments to doctors and other health care providers (going beyond the cuts already included in Obamacare) and by discouraging seniors from buying generous Medigap policies that don't encourage them to be cost-conscious.
    It also includes $95 billion in higher tobacco taxes over 10 years to pay for the Children's Health Insurance Program (CHIP) extension, which will expire at the end of this year unless Congress intervenes, among other things. This would nearly double taxes on cigarettes and small cigars to nearly $2 per pack (and index the tax for inflation).
    President Obama's budget proposes a 5.5% increase in funding for research and development ($146 billion over 10 years) that would include more money for the NIH, Department of Energy, National Science Foundation, and a "Precision Medicine" initiative that will try to develop more personalized approaches to medical treatments and cures.

    Comparison of Obama budget proposal to previous years funding for select programs:

      NIH EMSC TBI PCCs Children's
    Hospital
    GME
    Telahealth Injury
    Prevention
    (CDC)
    FY 14 $29.9b $20m $9m $19m $265m $14m $151m
    FY 15 $30.5b $20m $9m $19m $265m $15m $189m
    FY 16
    Proposal
    $31.3b $20m $9m $19m $100m $15m $257m

    House Votes to Repeal ACA
    The House voted on Tuesday to completely repeal the Affordable Care Act (ACA), also known as Obamacare. The repeal effort in the House was led by Rep. Bradley Byrne (R-AL) and instructs the congressional health committees to craft a new, alternative health care law, but does not explicitly impose a deadline for the new legislation to be produced.
    The measure was approved by a vote of vote of 239-186, despite opposition from all House Democrats and three Republicans – Reps. Bob Dold (R-IL), John Katko (R-NY) and Bruce Poliquin (R-ME). The Senate is expected to consider the measure, but it is unlikely that there will be enough votes to overcome a Democratic filibuster.

    Several Republicans Unveil Obamacare Replacement Plan
    On Wednesday, Sen. Orrin Hatch (R-UT), Sen. Richard Burr (R-NC) and Rep. Fred Upton (R-MI) released a plan to replace the Affordable Care Act. The plan would keep some of the more popular consumer protections enacted under the ACA, but would limit the law's subsidies that help people purchase coverage through the insurance exchanges.
    The proposal would also halt the ACA's Medicaid expansion, reduce the federal government's regulation of health plans, and includes medical liability reforms. To view the legislative proposal, please click here

    News on the SGR
    The bipartisan, bicameral legislation (HR 4015, S 2000) proposed last year and supported by ACEP and many other physician groups and stakeholders, which would permanently replace Medicare's sustainable growth rate formula would cost $174.5 billion between fiscal years 2015 and 2025, according to a Congressional Budget Office report released earlier this week. The most recent projected cost is $30.5 billion higher than CBO's previous estimate.
    A November 2014 CBO report found that the measure would cost $144 billion over a budget window of 2015 to 2024. Although there was no change to the legislation, the cost increased because CBO added another budget year to its calculation.
    The eternal impediment to passing legislation that would permanently replacement the SGR continues to be finding a way to pay for it. Senate Finance Committee Chair Orrin Hatch (R-UT) on Wednesday said lawmakers are working on potential offsets to pay for an SGR fix. He added that he doubts lawmakers will hold hearings on the SGR prior to the April 1 deadline but said they "may have to."

    House Hearing on Seasonal Influenza
    This Tuesday, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee held a hearing on influenza. Officials from several federal health agencies testified at the hearing, which highlighted the debate on efficacy of vaccines as well as the recent measles outbreak. A list of witnesses can be found here.

    Senate Hearing on HHS Budget for FY2016
    On Wednesday, the Senate Finance Committee held a hearing to consider the Obama administration's fiscal 2016 budget request for the Department of Health and Human Services. A list of witnesses can be found here.

    Upcoming Hearings
    Next Tuesday, the Senate HELP Committee will hold a hearing entitled, “The Reemergence of Vaccine-Preventable Diseases: Exploring the Public Health Successes and Challenges.”
    For a list of witnesses, please click here

    On Wednesday, the Health Subcommittee of the House Energy and Commerce Committee will hold a hearing entitled, “Examining ICD-10 Implementation.” For further details, please click here.

    Also on Wednesday, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee will hold a hearing titled “Federal Efforts on Mental Health: Why Greater HHS [Health and Human Services] Leadership is Needed.” For a list of witnesses and to view the hearing, please click here.

    911 Network Advocacy Activities - ED Visits
    This week, Dr. Jim Kennedye hosted Kevin Kincheloe, District Director, and Emily Burner, health policy liaison for Sen. James Lankford (R-OK) in the ED at St. Francis Hospital in Tulsa.
    Rep. Lankford is a new member of the Senate who was elected to replace Sen. Tom Coburn, a physician, who retired.

    Please contact Jeanne Slade in the ACEP Washington DC office if you are interested in hosting an ED visit or meeting for your federal legislator.

    2015 Legislative Advocacy Conference and Leadership Summit
    Please save the date of May 3-6 to join hundreds of your ACEP colleagues in Washington DC to hear from congressional leaders and EM experts about the latest legislative and policy initiatives impacting your practice and patients. Spend Tuesday, May 5 on Capitol Hill meeting with your legislators and their staff to forge relationships and impart the value of emergency medicine to key decision makers. Wednesday, May 6 will be devoted to a brand new Leadership Summit where you can hear from some of the most influential members of your specialty while earning CME credit.

    Registration information and additional details are available on the ACEP Website. Registration opens soon!

  • Weekly Update, January 30, 2015

    The Senate was in session this week and the House was in session early in the week. House Democrats held their policy retreat in Philadelphia from Wednesday through Friday.

    With Senate passage this week of legislation (S.1) to approve the Keystone XL pipeline project comes the veto showdown both parties have been anticipating. But the House and Senate first need to reconcile the differences between the versions they passed this month.

    House Energy & Commerce Holds Hearing on Trauma Care Legislation
    On Tuesday, the House Energy and Commerce Health Subcommittee held a hearing to discuss public health legislation, including several bills of importance to ACEP, which were under consideration during the previous Congress but that were not enacted. The "Trauma Systems and Regionalization of Emergency Care Reauthorization Act" would reauthorize two programs to provide grants to states for planning, implementing and developing trauma care systems, as well as to launch several pilot projects to design, implement and evaluate innovative models of regionalized emergency care and trauma systems. The "Access to Life-Saving Trauma Care for All Americans Act" would reauthorize Trauma Care Center Grants to support their core missions, curtail losses from uncompensated care and provide emergency awards to centers at-risk of closing, as well as Trauma Service Availability Grants to address shortfalls in trauma services, especially in underserved areas. The "Veteran Emergency Medical Technician Support Act" would streamline the process for veterans with military emergency medical training to become civilian EMTs. The "National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization Act" would help promote the use of state prescription drug monitoring programs to help reduce abuse and diversion of prescription controlled substances.
    ACEP will continue to work with the sponsors of these important bills on their re-introduction in the 114th Congress and, ultimately, their passage into law.

    Senate Finance Committee Markup - Hire More Heroes Act
    The Senate Finance Committee considered its first piece of legislation of the 114th Congress on Wednesday during a mark-up of a bipartisan measure to incentivize the hiring of veterans and modify parts of the Affordable Care Act. The House passed the "Hire More Heroes Act" earlier this year by a 412-0 vote, which was the chamber's first vote addressing the ACA in this Congress. Under the measure, companies could exempt veterans who receive healthcare through the Veterans Administration when determining if they are subject to the ACA employer mandate. Backers of the bill say such a move would allow companies to hire more workers. The Congressional Budget Office (CBO) has estimated that the measure would add $858 million to the federal debt over a decade, by reducing the tax burden of companies that no longer meet the threshold of 50 or more full-time employees needed to trigger the employer mandate. The Senate did not take up the measure in the previous Congress, when it also passed the House overwhelmingly.

    FDA Reform and Health Initiatives

    Both the House and Senate have begun the process of examining ways to accelerate the discovery, development and implementation of cures and treatments. This week, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and committee member Rep. Diane DeGette (D-CO) released draft legislation entitled, "21st Century Cures," to streamline the approval process of drugs and medical devices. The bill also may include provisions to expand Medicare physician reimbursement when providing telehealth services.
    In the Senate, this effort is being led by the HELP Committee. Two of the committee members, Chairman Lamar Alexander (R-TN) and Sen. Richard Burr (R-NC), released a report yesterday, "Innovation for Healthier Americans," on the challenges to getting safe treatments, devices and cures to patients more quickly and effectively. To read the report, click here.
    Additionally, the President is scheduled to release his budget proposal for FY2016 on Monday. Included in the budget of note, is a major biomedical research initiative, which the President announced today. The initiative included plans to collect genetic data on one million Americans so that scientists can develop drugs and treatments tailored to the characteristics of individual patients. White House officials said the “precision medicine initiative,” also known as personalized or individualized medicine, would begin with a down payment of $215 million in the president's budget request for the fiscal year that starts on Oct. 1.
    Federal officials described the project as a research consortium that would collect information from large numbers of people. The data could include medical records, laboratory test results, profiles of patients' genes, and information about their diet, tobacco use, lifestyle and environment.
    The president's budget request includes $130 million for the consortium and an additional $70 million request for the National Cancer Institute, to investigate genes that may contribute to the risk of developing certain types of cancer, and then to use that knowledge to develop more effective treatments.

    Senate Committee Passes Veterans Suicide Prevention Bill
    On Wednesday, the Senate Veterans Affairs Committee passed legislation intended to address suicide among veterans. Earlier this month, the House unanimously passed the "Clay Hunt Suicide Prevention for American Veterans Act" (H.R.203) introduced by Rep. Tim Walz (D-MN). The legislation will require annual reviews of the effectiveness of VA suicide prevention programs and offer a student loan repayment pilot program to recruit more mental health specialists. Members of both parties have indicated support for the bill and the legislation is now in the queue for full Senate consideration.

    House Committee Examines Cost & Quality of Veteran Health Care
    On Wednesday, the House Veterans Affairs Subcommittee on Health held a hearing to examine the cost and quality of VA health care. For a list of witnesses and to view the hearing, please click here.

    Upcoming Hearing on Seasonal Influenza
    On Tuesday, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee will hold a hearing to examine the U.S. public health response to seasonal influenza. A list of witnesses can be found here.

    House Approves Package of Bills Related to Human Trafficking
    January 2015 is National Slavery and Human Trafficking Prevention Month. On Monday and Tuesday of this week, the House passed a dozen bills to combat human trafficking. More information about these bills is available here.

    Federal Exchange Subsidies
    Republicans in Congress have said they will not take action to preserve subsidies to help U.S. residents purchase coverage through the federal exchange if the Supreme Court rules they are illegal. The high court is set to consider King vs. Burwell in March determining whether the wording of the 2010 health law means people can only get tax credits to lower their health premiums if they live in one of the handful of states running its own insurance exchange. A decision is expected by June.
    If the court strikes down the subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis.
    If the subsidies are ruled illegal, Democrats in the House and Senate likely will push for legislation to make them available. Senate Republican leadership stated no member of their conference has said lawmakers should move to continue the subsidies if they are found to be illegal, especially since doing so would also mean upholding the ACA's individual mandate.

    House to Vote on ACA Repeal Next Week
    In related news, the House next week will vote on a measure (H.R.596) to repeal the ACA in its entirety. The upcoming vote will mark the first vote to repeal the ACA in full during the new 114th Congress. The last vote on such a measure was in May 2013. Overall, the vote will mark close to the 60th attempt by Congress to repeal all or part of the law since its enactment.
    The bill is expected to include instructions to the relevant committees to develop Republican health care reforms to replace the ACA.

    ACEP Members Host ED Visits and New Member Coffees for Legislators
    With 61 new members in the House of Representatives, 13 new Senators, and new committee chairs and appointees to key health care committees in Congress, there are many new players and personalities who will have a role in the development and consideration of health care legislation. It's ACEP's goal, with your help, to get to know them - their interests, concerns, priorities, local and Washington, D.C. staff.
    We are scheduling ED tours and coffees with these members and ACEP 911 Network members to help them understand what emergency physicians face on a day-to-day basis and what you bring to their constituents. These meetings are often the start to a mutually beneficial relationship founded on trust, good information, and community ties.

    Thank you to the following ACEP members who have taken time to conduct these tours or meetings so far this year:
    Dr. Greg Shangold for Sen. Chris Murphy (D-CT) at Windam Hospital
    Dr. Nick Vasquez with Rep. Ruben Gallego (D-AZ)
    Dr. Brad Uren with Rep. Mike Bishop (R-MI)
    Dr. Marilyn Heine with Rep. Brendan Boyle (D-PA)
    Dr. Hans House with Sen. Joni Ernst (R-IA)
    Dr. Ian Ferguson with Anne Ream, Senior Field Representative for Rep. Anna Eshoo (D-CA) at Santa Clara Valley Medical Center

    Please contact Jeanne Slade in the Washington DC office if you are interested in hosting an ED visit or coffee in the district.

  • Weekly Update, January 24, 2015

    The House and Senate were in session this week through Thursday evening and will return on Monday. Upon their return, the Senate is expected begin winding down debate on the bill to approve the Keystone XL pipeline.

    Action this Week

    House Holds Two-Day Hearing on Sustainable Growth Rate (SGR)
    The House Energy and Commerce Subcommittee on Health kicked off a two-day hearing on Wednesday to discuss ways to reform the flawed Sustainable Growth Rate formula and offset the approximate $140 billion cost. The struggle and challenges associated with coming up with offsets continue to plague the new Congress. The current temporary “doc fix” measure expires on March 31, 2015. If Congress does not take meaningful action, physicians face Medicare reimbursement cuts of up to 24%. Since 1997 when the formula was enacted into law, Congress has passed 17 short-term patches, which have cost over $170 billion. For further details and to view the hearing, please click here.

    State of the Union Recap
    On Tuesday evening, the President gave his second to last State of the Union address to Congress as he enters the third year of his second term. Although it was not a major focus of the speech, President Obama included several references to health care in his State of the Union address. Specifically, Obama noted that "about 10 million uninsured Americans finally gained the security of health coverage" over the past year. In addition, Obama said that health care inflation was at its lowest rate in 50 years. Further, Obama threatened to veto any bill passed by Congress that would "put the security of families at risk by taking away their health insurance." Finally, Obama announced the launch of a "Precision Medicine Initiative," which would seek to "bring us closer to curing diseases like cancer and diabetes," but he did not include many details of the project.
    Newly elected Iowa Senator Joni Ernst gave the official Republican response focusing on the GOP's policy priorities for the new Congress, rather than making a direct response to President Obama's proposals.
    Economic anxiety of middle-class Americans has emerged as a prominent theme with Republicans offering their own ideas to counter President Barack Obama’s State of the Union address. Democrats and Republicans—including the White House and those in Congress and the emerging 2016 presidential field—have begun to coalesce around the idea that a lagging middle class is the major blemish on a recovery so far defined by a rising stock market, a falling unemployment rate and overall economic growth. While there are differences between and within the parties over policy, there is no doubt over what aspect of the economy will take focus.

    Definition of Full-Time Employee in ACA
    Senate Republicans are not making much headway in convincing more Democrats to join them in making a significant change to the ACA by backing a bill redefining full-time employment as 40 hours per week instead of 30 hours, as the ACA does now.
    Republicans need four more Democrats, in addition to the two they have already brought on board (Sens. Manchin (WV) and Donnelly (IN)), to back a measure for changing the work-week definition so they can bring the bill to a Senate vote. The House already has passed its version of the measure by a 252-172 margin, with 12 Democrats joining all Republicans in voting in favor of the change.
    Sixty votes are required in the Senate to force a vote on a bill when some senators want to continue debate or filibuster. That means Republicans, even with their new Senate majority, need at least six Democrat senators to back the Forty Hours Is Full Time Act of 2015, also known as S.30.
    The full Senate Committee on Health, Education, Labor & Pensions Thursday held hearings to garner support for S. 30, which was introduced Jan. 6 by Sen. Susan Collins(R-ME).
    Under the federal healthcare law, businesses with at least 100 employees must offer coverage this year to most full-time workers or face a financial penalty, typically $2,000 per worker. In 2016, the employer mandate will apply to businesses with 50 or more employees. Proponents of the bill say the 30-hour standard diverges from the widely accepted definition of full-time work and so could be used as an incentive for employers to reduce hours, particularly for low-wage workers, to avoid offering healthcare coverage. Those who oppose attempts to redefine the work week say it's an effort to derail funding for the ACA and raise the deficit. A recently released Congressional Budget Office report backs their arguments, they say.
    The report found that changing the work week definition to 40 hours would increase the federal deficit by $53 billion over a decade, largely because fewer employers would pay penalties. It also determined that 1 million fewer individuals would be offered coverage through their jobs if the full-time threshold changed to 40 hours per week.
    Even if the Senate ultimately succeeds in passing S.30, President Obama already has announced that he would veto the legislation.

    Upcoming Congressional Hearings
    On Tuesday, January 27, the House Energy and Commerce Health Subcommittee will hold a hearing on a series of public health legislation. The Committee is looking to build upon some of the bipartisan legislation that garnered support in the House from the previous Congress and several ACEP-supported bills will be discussed such as:

    The Ensuring Patient Access to Effective Drug Enforcement Act, authored by full committee Vice Chairman Marsha Blackburn (R-TN) and Reps. Tom Marino (R-PA), Peter Welch (D-VT), and Judy Chu (D-CA). This bill would improve enforcement efforts regarding prescription drug diversion and abuse. This bill was approved by the full House in July of 2014.

    The Improving Regulatory Transparency for New Medical Therapies Act, authored in the previous Congress by Subcommittee Chairman Pitts and Frank Pallone (D-NJ), now Ranking Member of the full committee. This bill would amend the Controlled Substances Act to improve the efficiency, transparency, and consistency of the Drug Enforcement Agency’s process for scheduling new drugs approved by the Food and Drug Administration.

    The Veteran Emergency Medical Technician Support Act, authored by Reps. Adam Kinzinger (R-IL) and Lois Capps (D-CA). This bill would provide demonstration grants to states with a shortage of emergency medical technicians (EMTs) to streamline state-licensing requirements for military veteran EMTs to prevent unnecessary duplication in training. This bill was approved by the full House in February 2013.

    The Trauma Systems and Regionalization of Emergency Care Reauthorization Act authored by Rep. Michael C. Burgess, M.D. (R-TX) and Health Subcommittee Ranking Member Gene Green (D-TX). This bill would reauthorize Trauma Care Systems Planning Grants, which support state and rural development of trauma systems. It would also reauthorize pilot projects to implement and assess regionalized emergency care models. This bill was approved by the House in June 2014.

    A bill to reauthorize language from the Public Health Service Act to fund trauma care centers. This funding is set to expire in Fiscal Year 2015.

    The National All Schedules Prescription Electronic Reporting (NASPER) Reauthorization Act. This bill, authored by Rep. Ed Whitfield (R-KY), would reauthorize the NASPER program to support state prescription drug monitoring programs.

    Wednesday, January 28th the Health Subcommittee of the House Veterans’ Affairs Committee will hold a hearing titled “Examining the Quality and Cost of VA Health Care.” Further details on the hearing can be found here.

    On February 3rd, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee is tentatively scheduled to hold a hearing on influenza. Further details to be determined next week.

  • Weekly Update, January 16, 2015

    After a short week of congressional business, House and Senate Republicans headed to Hershey, PA on Wednesday for their first join conference retreat since 2004 to decide on a course of a congressional action for FY 2015 through September. Senate Democrats held their retreat in Baltimore.

    House Health Subcommittee Schedules Hearings on SGR
    The Energy and Commerce Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), has scheduled a two-day hearing for Wednesday, January 21, and Thursday, January 22 to discuss how to address Sustainable Growth Rate (SGR) reform before the current patch expires at the end of March 2015. Last year, the House of Representatives approved H.R.4302, the “Protecting Access to Medicare Act,” bi-partisan legislation to permanently repeal the SGR. The Senate did not take up the legislation. Witnesses have not yet been announced for the hearing. The hearing webcast will be available at http://energycommerce.house.gov/.

    ACEP Responds to House Request for GME Information
    In December, members of the House Energy and Commerce Committee asked stakeholders to provide input on various aspects of the current Graduate Medical Education (GME) system, including its financing, governance and program design. They requested this information to help them as they prepared to review the GME recommendations made by an Institute of Medicine (IOM) committee in July.
    Of note, two of the IOM committee recommendations were to phase-out the separate Direct and Indirect GME payments currently paid to teaching hospitals (replacing them with one geographically adjusted national per-resident amount that would go to GME training program sponsors); and to terminate Medicare support for the program in 10 years (without identifying an alternative funding source). ACEP was very concerned with some of these recommendations, especially at a time when the nation is projected to face a physician shortage of more than 130,000 physicians by 2025.
    In response to the request, ACEP President Mike Gerardi, MD, FACEP, sent a letter to the committee noting how the projected physician shortage would impact the delivery of emergency care; explaining the need for more residency trained, board certified emergency physicians; advocating for additional transparency; and citing disincentives for many physicians, especially emergency physicians, to do rural rotations; among other things. To read Dr. Gerardi's letter, click here.

    House Approves Suicide Prevention Program for Vets
    In an effort to slow the nation's estimated 22 veteran suicides each day, on Monday, the House unanimously passed the "Clay Hunt Suicide Prevention for American Veterans Act" (H.R.203), introduced by Rep. Tim Walz (D-MN). The legislation will require annual reviews of the effectiveness of VA suicide prevention programs and offer a student loan repayment pilot program to recruit more mental health specialists. Members of both parties overwhelmingly supported the bill by a vote of 403-0. It now heads to the Senate, where it is expected to be approved easily.
    Last month, in the waning days of the last congressional session, House lawmakers expedited the Clay Hunt Act through their chamber in hopes of making it law before the end of 2014. But, that plan hit a snag in the Senate, when retiring Sen. Tom Coburn (R-OK), blocked its passage, calling it redundant and rushed legislation.
    Senate Veterans Affairs Committee Chairman Johnny Isakson (R-GA) has indicated the Clay Hunt bill will be among the first items considered when his committee begins its work later this month. It is also possible that Senate lawmakers in coming days could bypass the normal committee process and send the bill before the full chamber for a vote. Since Senator Coburn's departure, no senators have publicly objected to the measure.

    Legislation Addresses Emergency Responders and the Employer Mandate
    Also on Monday, the House unanimously voted to approve the "Protecting Volunteer Firefighters and Emergency Responders Act" (H.R.33). The bill sponsored by Rep. Lou Barletta (R-PA) ensures that emergency service volunteers are not counted as full-time employees by the Internal Revenue Service (IRS) under the Employer Mandate of the Affordable Care Act. Rep. Barletta authored the same legislation in the 113th Congress and it passed the U.S. House on March 11, 2014 by another unanimous vote of 410-to-0, but the legislation was never addressed in the Senate.
    The IRS declined to indicate how it would classify hours of service for emergency volunteers under the ACA, meaning that fire companies and municipalities could be forced to provide volunteers with health insurance or pay a fine. Under the Employer Mandate Provision of the ACA, employers with 50 or more employees must provide health insurance or pay penalties. If volunteers were ever considered employees, fire companies could exceed the 50 employee threshold in several different ways: a volunteer department by itself based on size; by being part of a combined, paid-volunteer firefighter department; or by being part of a municipality that has 50 or more public employees in total.

    DHS Funding Bill Passes the House
    The House voted 236-191 on Wednesday to pass a $40 billion appropriations bill that would fund the U.S. Department of Homeland Security (DHS) through the remainder of the fiscal year. Final passage of the spending bill came after a series of controversial amendments were approved that sought to undo some of President Obama’s executive orders on immigration. The action puts the House on a collision course with Senate Democrats and the White House and could lead to a partial shutdown of the DHS if a compromise cannot be reached by the end of next month. DHS is currently funded through Feb. 27.

    CMS Administrator to Step Down
    After five years on the job, Marilyn Tavenner, administrator of the Center for Medicaid and Medicare Services (CMS), announced her departure Friday, which will take effect next month. Her tenure included the rollout of the Affordable Care Act (ACA), the country's largest expansion of Medicaid since its formation and appearances at numerous congressional hearings on the ACA. Tavenner’s chief of staff, Aryana Khalid, also announced Friday that she would be leaving the agency. The pair of departures comes about a month after that of CMS’s deputy administrator, Cindy Mann.

    Chances for Bi-Partisanship on Health Care Issues this Year?
    HHS Secretary Sylvia Mathews Burwell on Thursday outlined potential areas of common ground on the ACA and other health issues in a speech at the New America Foundation. Burwell noted that Administration would defend the ACA, but also wants to find areas where it can be improved.
    For example, she said that lawmakers could find common ground on legislation (H.R.22) that would exempt certain veterans from the ACA's employer mandate. Burwell also said that disagreements over the ACA should not prevent the Administration and Congress from addressing other areas in health care where there are common interests such as:

    • Addressing prescription drug misuse and drug overdoses;
    • Building an innovation economy;
    • Combatting the Ebola virus;
    • Encouraging drug development and research and furthering scientific innovation;
    • Improving global health security;
    • Making improvements in care quality and value

    She also mentioned that reauthorizing CHIP and addressing the SGR could be areas to find bi-partisan support.

    2016 Election News
    Despite the new 114th Congress just getting started, there is already news of members who have decided not to run for re-election in 2016. After nearly four decades in public life, Sen. Barbara Boxer (D-CA) announced she would retire after this session. The names of potential candidates in the race to replace her includes Attorney General Kamal Harris, Rep. Jackie Speier (D-CA), Rep. Xavier Becerra (D-CA) billionaire climate activist Tom Steyer and LA Major Eric Garcetti. Sen. David Vitter (R-LA) also will retire to run for Governor in Louisiana.
    In the House, Reps. Mike Fitzpatrick (R-PA) and Chris Gibson (R-NY) have decided to retire at the end of this Congress. And, just weeks after a somewhat surprising re-election to Congress, Rep. Michael Grimm (R-NY) resigned after pleading guilty to federal tax evasion.
    A special election to fill his seat must be held within 70-80 days of his announcement made on Dec 30.

  • Weekly Update, January 9, 2015

    The new 114th Congress convened this week with 58 freshmen members of the House, 43 Republicans and 15 Democrats, increasing the Republican majority to 246 members, the most since the Great Depression. In the Senate, 13 new lawmakers, one lone Democrat and 12 Republicans, were sworn in, flipping control of the chamber to Republicans who will have a 54-vote majority.

    Currently there are more questions than answers regarding the path that the 114th Congress will take in addressing important budget and health law decisions. House and Senate Republicans will hold their party retreats in mid-January to fashion the course the House and the new Republican majority in the Senate will pursue to finish fiscal year (FY) 2015 Department of Homeland Security appropriations, the FY 2016 budget resolution and respective appropriations, as well as critical decisions involving health care.

    Hire More Heroes Act
    One of the first votes in the new Congress on Tuesday was on legislation, introduced by Rep. Rodney Davis (R-IL), to incentivize businesses to hire more veterans by excluding them from the Affordable Care Act's employer mandate. The House passed the "Hire More Heroes Act" (H.R.22) on Tuesday by a vote of 412-0.
    Under the bill, employers could exclude veterans who receive health coverage through programs like TRICARE provided by the Department of Defense or the Department of Veterans Affairs from their lists of workers in order to avoid Obamacare's employer mandate.
    Under the health care law's requirement set to go into effect this year, employers with 50 or more full-time workers must provide health insurance.
    In the previous Congress, the House passed an identical measure last March by a vote of 406-1, but it stalled in the Senate. Timing of a vote in the Senate is unclear and the Obama Administration has not indicated whether or not they will veto the bill.

    Save American Workers Act
    The House yesterday voted 252-172 to approve the “Save American Workers Act” (H.R.30), legislation that would change the definition of full-time workers under the Affordable Care Act's employer mandate from 30 hours per week to 40 hours per week. Consequently, only employees who work an average of 40 hours a week would be considered full-time workers and count toward the 50-employee threshold that triggers the requirement under the 2010 law that businesses offer affordable health coverage to their employees or pay a tax penalty.
    The bill now goes to the Senate for consideration, despite the veto threat from the White House issued earlier this week. The Congressional Budget Office (CBO) assessment has created additional challenges as it stated the bill would boost the deficit; result in more people uninsured and on Medicaid; and potentially reduce, not increase, the number of hours worked by full-time workers.

    Three-Day Hospital Inpatient Requirement
    Members of the ACEP Government Affairs team along with other key advocates met with Rep. Joe Courtney (D-CT) to discuss the re-introduction of a bill which seeks to modify Medicare’s Three-Day Inpatient Requirement ensuring seniors have appropriate access to post-acute services. ACEP will keep you updated on the bill status as it is reintroduced in the 114th Congress.
    Previously in Congress, ACEP supported H.R.1179/S.569, the “Improving Access to Medicare Coverage Act of 2013.” ACEP continues its advocacy on the idea that all days spent receiving care in a hospital should count toward Medicare’s three-day hospital stay requirement, regardless of their status as an inpatient or outpatient.

    Supreme Court Decision Could Cause Decline in Coverage of Uninsured
    The number of U.S. residents with health insurance could drop by about 9.6 million if the Supreme Court deems illegal the subsidies to help individuals purchase coverage through the federal exchange, according to a new RAND Corporation study.
    The Supreme Court in December 2014 announced that it will hear oral arguments in King v. Burwell on March 4, meaning the court likely will release a decision on the case by the end of June. At issue is that while the Affordable Care Act says subsidies are available to help certain U.S. residents purchase coverage offered "through an exchange established by the state," a May 2012 IRS rule allows the subsidies to be used in an exchange administered either by a state or the federal government.
    The plaintiffs argue that the IRS rule should be invalidated because it contradicts what Congress originally wrote in the ACA. The RAND researchers wrote that if the high court declares the subsidies illegal in the federal exchange, the number of U.S. residents with coverage purchased on the individual market would decline from 13.7 million to 4.1 million.
    The researchers explained that the drop would be caused by a series of events. First, those losing subsidies likely would drop coverage, which would decrease the number of people in the insurance pool. In turn, premiums would rise -- by as much as 50%, according to the researchers' estimates -- for those who remain in the individual market, regardless of where they obtained coverage.
    The higher premiums would then cause more individuals to drop coverage.
    The RAND study follows an Urban Institute analysis last year that found a ruling to end the subsidies would cause 7.3 million low- and middle-income U.S. residents to miss out on $36 billion to help them purchase coverage in 2016.

    Update on the ACEP 911 Network
    As the large roster of freshmen Members, a new majority in the Senate new health committee chairs and members begin work in the 114th Congress, now is the perfect time for ACEP to ramp up our grassroots strategy to reach both new and veteran members in Washington DC and on their home turf.
    The mission of the 911 Network is to Educate and Engage legislators, while Expanding the “footprint” of emergency medicine in the development of quality health care legislation and policy on the federal level. With a network of emergency physician advocates in every congressional district across the country, we can ensure that emergency medicine and our issues receive the right amount of visibility.
    As we will have much to do this year, we are looking for 911 Network members who are interested in taking their advocacy to the next level by becoming a Team Captain.
    Team Captains are self-identified ACEP advocates who want to play a more substantive role in national policy and advocacy efforts on behalf of emergency physicians and their patients.

    We ask for a two year commitment (the length of one congressional session). Additional activities may include:

    • Develop on-going communications with Member of Congress’ legislative staff person responsible for health issues
    • Participate in a district meeting in a Member of Congress’ local office, preferably with the Member but also with staff
    • Join Member of Congress’ social network including Facebook, Twitter, etc. as applicable
    • Host an Emergency Department visit for a Member of Congress and/or staff
    • Deliver a NEMPAC check locally to a congressional candidate if requested by the ACEP national office or attend a local fundraiser as a representative of ACEP
    • Attend the annual Leadership and Advocacy Conference in Washington, DC
    • Participate in Team Captain/State Leader conference calls, Advocacy Webinars and/or Teleforums as scheduled.
    If you are interested, please contact Jeanne Slade in the ACEP Washington DC office at jslade@acep.org or Gabrielle Szlenkier at gszlenkier@acep.org or 202-728-0610, ext. 3013.

  • Weekly Update, December 15, 2014

    Weekend Action in Senate Avoids Government Shutdown
    Late Thursday night, the House approved a massive, $1.1 trillion spending package to fund most federal departments and programs through the remainder of the current fiscal year (ends Sept. 30). The only exception is for operations at the Department of Homeland Security (DHS), which will be funded through Feb. 27. The short-term funding for DHS was a by-product of GOP opposition to President Obama’s recent Executive Order on immigration. The agency that oversees the deportation process for illegal immigrants is housed within DHS and Republicans intend to use this temporary funding as a mechanism to retain oversight of these activities.
    At times, it was unclear if the House would be able to muster enough votes to approve the omnibus spending measure. The rule to debate the bill passed by a very slim margin and when the House completed its debate on the bill, Republican leaders needed several additional hours to confirm they would have enough support before bringing the bill up for a final vote.
    Democratic opposition to the bill was mainly due to objections over two extraneous provisions (one to loosen banking regulations that were enacted by the Dodd-Frank Act and the other to allow individual donors to contribute substantially more money to national party committees). Republican opposition focused on their concern that stronger measures were not included to reverse President Obama’s immigration order. Ultimately, 57 Democrats joined 162 Republicans to approve the measure by a vote of 219 to 206.
    However, due to the delayed action on the bill, the Senate had to pass a two-day Continuing Resolution to keep the government operating past the midnight deadline so that they would have time to consider the omnibus spending package. Recognizing this possibility, the House also approved the temporary funding provision following the vote on the larger bill.
    On Saturday, the Senate reached a deal to clear the spending packages after lawmakers in both parties sparred over who was to blame for the impending shutdown theatrics.
    The final vote was 56-40 in an extremely bipartisan vote, with 21 Democrats, 18 Republicans and independent Bernard Sanders of Vermont voting no.

    Highlights of the FY15 Omnibus Appropriations bill:

    • $1.1 trillion in total spending ($521 billion for defense programs and $492 billion for non-defense programs);
    • Full funding through the remainder of FY15 for 11 of the 12 annual appropriations bills (with the exception of DHS, which is funding through Feb. 27);
    • $30.1 billion for NIH (+$150 million);
    • Rescinds $10 million from the Independent Payment Advisory Board (IPAB);
    • $5.4 billion for emergency Ebola programs ($155 million for Public Health Emergency Preparedness (including PPE and training) and $255 million for state and local activities);
    • $265 million for Children's Hospitals GME (same level);
    • $32 million for Prescription Drug Abuse and Prevention ($20 million at CDC and $12 million at SAMHSA);
    • $4.5 million for Rural Access to Emergency Devices (the $1.1 million increase in the program is dedicated to purchasing "emergency devices used to rapidly reverse the effects of opioid overdoses")
    • $14.9 million for Telehealth (+$1 million);
    • $9.3 million for Traumatic Brain Injury (TBI) (-$23,000);
    • $20.2 million for Emergency Medical Services for Children (EMSC) (-$51,000);
    • $18.8 million for Poison Centers (same level);
    • $170 million for Injury Prevention and Control (+$19 million);
    • $1.4 billion for Public Health Preparedness and Response (same level);
    • $461 million for Community Mental Health Services Block Grants (-$1.2 million); and
    • $1.7 billion for Substance Abuse and Prevention Block Grants (same level)
    Remaining Business in the Senate
    With just a few hours left in the majority, Senate Democratic leaders will compel lawmakers to stay in Washington today and tomorrow to consider a handful of executive nominations including Vivek Murthy for Surgeon General. Otherwise, it's game over for nearly every piece of legislation still languishing in these final hours of the 113th Congress, but enactment appears possible for the plan (H.R.5771) to retroactively extend more than 50 tax breaks and a measure (S.2244) that would reauthorize the federal program for helping insure risk of terrorist attacks.
    Leaders are still trying to negotiate a deal to clear the two bills, which Senate Democrats are expected to use as leverage to keep Republicans from leaving town before a slew of Obama administration nominees are confirmed.

    House Committee Looks at Entitlement Financing
    On Tuesday, the House Energy and Commerce Health Subcommittee held a hearing entitled “Setting Fiscal Priorities.” The Subcommittee panel met to scrutinize federal spending in Medicare, Medicaid and the Affordable Care Act (Obamacare). The panel sought to find policy changes that would generate savings for the federal budget, a task that will be a focus for GOP lawmakers in the next Congress.
    Republicans are preparing to take aim at federal programs they consider wasteful, including pieces of the Affordable Care Act. Some priorities such as repealing the medical device tax, ACA mandates and IPAB already have bipartisan support. During the hearing, Democrats noted that U.S. healthcare spending grew at a record-low rate in 2013, a trend experts attribute to the slow economy and reforms created by the healthcare law.
    However, some GOP members suggested that savings generated from ACA policy changes could be put toward offsetting some of the cost of overhauling Medicare reimbursement policies in the future.
    Many members contended that the constant SGR debate has shifted federal attention away from other necessary health reforms. Some witnesses during the hearing urged lawmakers to find a permanent solution for avoiding the scheduled March cuts. Some of their recommendations for offsetting the cost included identifying overpriced services, instituting payment updates that are higher for primary care than specialty care and establishing a primary care bonus that is funded by non-primary care services.
    MedPAC, the nonpartisan commission that advises Congress on issues affecting Medicare, suggested short-term ways for reducing federal health costs and improving the program could include updating the fee-for-service payment rates, creating site-neutral payments, bundling payments and incentivizing reductions in readmission rates in an effort to encourage cheaper and better quality of care.

    House Committee Reviews ACA Transparency
    Also on Tuesday, the House Oversight and Government Reform Committee held a hearing titled, “Examining ObamaCare Transparency Failures.” Much of the hearing’s focus was directed at the MIT professor, Johnathon Gruber, who has been accused of making derogatory remarks regarding the president’s healthcare law while serving as an advisor to the White House. Throughout the hearing, Mr. Gruber sought to downplay his relationship with the Obama Administration and stressed that he was not an architect of the law or a political adviser.

    Senate Committee Continues Ebola Oversight Hearings
    On Wednesday, the Senate Foreign Relations African Affairs Subcommittee held a hearing titled, "The Ebola Epidemic: The Keys to Success for the International Response." Much of the hearing focused on the expanded U.S. and international efforts to combat Ebola in Africa, especially as it pertains to the country of Liberia.

    VA Mental Health Bill Clears the House
    The House passed a bill Tuesday to improve mental health care for veterans, but it’s unclear if it will pass the Senate and become law before Congress adjourns for the year. The “Clay Hunt Suicide Prevention for American Veterans Act” (H.R.5059) passed the House unanimously by voice vote. The bill would require annual evaluations of mental health programs at both the VA and the Defense Departments, as well as authorize the VA to collaborate with veteran’s service organizations and mental health nonprofits to improve care.
    Despite the overwhelming support in the House, there are some in the Senate who might object to the $22 million cost (over five years) of the bill, which is not offset and breaks the caps set in last year’s budget agreement.
    Lawmakers acknowledged that the bill would not end veterans’ suicide or cure all of the VA’s problems. But it does make some changes, including an interactive website active-duty troops and veterans will be able to visit to learn about all available mental health resources in one easy-to-access place. Furthermore, the bill also establishes a pilot program for the Department of Veterans Affairs to offer student loan repayment incentives to recruit and retain psychiatrists, one of the most understaffed specialties at the VA. The doctors must stay at the VA for at least two years to receive the benefit.

    Update on Future Activities of ACEP 911 Network
    As the dust settles from the midterm elections, one thing is clear: there is a large roster of freshmen Members entering the 114th Congress, a new majority in the Senate and new leaders and committee chairs and members. Now is the perfect time for ACEP to ramp up our grassroots strategy to reach both new and veteran members in Washington DC and on their home turf.

    The mission of the 911 Network is to Educate and Engage legislators, while Expanding the “footprint” of emergency medicine in the development of quality health care legislation and policy on the federal level. With a network of emergency physician advocates in every congressional district across the country, we can ensure that emergency medicine and our issues receive the right amount of visibility.

    As we will have much to do next year, we are looking for 911 Network members who are interested in taking their advocacy to the next level by becoming a Team Captain.

    Team Captains are self-identified ACEP advocates who want to play a more substantive role in national policy and advocacy efforts on behalf of emergency physicians and their patients. We ask for a two year commitment (the length of one congressional session). Additional activities may include:
    • Develop on-going communications with Member of Congress’ legislative staff person responsible for health issues
    • Participate in a district meeting in a Member of Congress’ local office, preferably with the Member but also with staff
    • Join Member of Congress’ social network including Facebook, Twitter, etc. as applicable
    • Host an Emergency Department visit for a Member of Congress and/or staff
    • Deliver a NEMPAC check locally to a congressional candidate if requested by the ACEP national office or attend a local fundraiser as a representative of ACEP
    • Attend the annual Leadership and Advocacy Conference in Washington, DC
    • Participate in Team Captain/State Leader conference calls, Advocacy Webinars and/or Teleforums as scheduled.
    If you are interested, please contact Jeanne Slade in the ACEP Washington DC office at jslade@acep.org or Gabrielle Szlenkier at gszlenkier@acep.org or 202-728-0610, ext. 3013. The Weekly Update will resume on January 9, 2015, when the 114th Congress convenes.

    Happy Holidays to all!

  • Weekly Update, December 5, 2014

    The Week Ahead
    The House and Senate are still tentatively scheduled to adjourn at the end of the next week for the final time in the 113th Congress. However, before they go home, action must be taken to avoid a government shutdown as the current, temporary bill funding the federal government is set to expire on Dec. 11.

    Government Funding Deadline Approaching
    House and Senate appropriators aim to have their all-encompassing spending bill done by this weekend so that it will be available for Members' review on Monday morning. The current plan outlined by the House leadership is to approve 11 of the 12 appropriations measures for the remainder of the fiscal year (through Sept. 30) and fund the Department of Homeland Security only through February. This would allow Republicans to keep attention on immigration issues raised by the recent presidential Executive Order.
    But some obstacles still remain in order to meet this deadline. Several controversial measures are still being debated and negotiated, such as policy disputes over a D.C. marijuana ballot initiative, EPA regulations and Ebola funding levels. Because a contingent of House (and Senate) conservatives have been criticizing the spending proposal for not blocking the president's action, House Speaker John Boehner (R-OH) will likely need Democratic votes to pass the plan.
    A government shutdown will occur without congressional action by Thursday (Dec. 11).

    Bill to Help Disabled Could Cost Physicians
    On Wednesday, the House of Representatives overwhelmingly approved, by a vote of 404 to 17, legislation (H.R. 647, the "Achieving a Better Life Experience (ABLE) Act") that would allow people with disabilities, or their caregivers, to create special savings accounts to pay for education, housing and medical expenses without jeopardizing their eligibility for other government benefits.
    Unfortunately, one of the off-sets used to pay for this legislation would accelerate the target dates for Medicare physician fee schedule redistributions, which were included in the last physician payment patch enacted in March.
    The original provision required CMS to meet annual targets for revising "misvalued" physician services (amounting to 0.5% of total fee schedule spending) through the years 2017-2020. If payment redistribution fell short of the 0.5% target in any of these four years, CMS would implement across-the-board cuts to all physicians equal to the amount of the deficiency.
    The funding mechanism in the ABLE Act revises the policy timeframe and imposes a 1.0% redistribution target in 2016, followed by 0.5% targets in 2017 and 2018.
    However, the more aggressive timeline is particularly problematic due to new policy changes announced by CMS in the 2015 Medicare Fee Schedule regulation released Oct. 31. CMS stated it needed to concentrate its efforts on implementing the proposal to eliminate the surgical 10-day and 90-day global payment services in 2017 and 2018. Consequently, CMS withdrew another proposal to review 68 CPT codes that represent the highest spending within the respective specialty.
    As stated by the AMA, the misvalued code redistribution cannot be met if the high expenditure services are not considered. Furthermore, the AMA believes this provision will effectively ensure physician services will be subject to the pro-rata reduction for at least some portion of the 2016-2018 timeframe.
    ACEP, the AMA and other physician organizations are urging the Senate to replace this provision with a different off-set when it considers the bill next week.
     
    NHTSA Nomination on Fast Track
    Mark Rosekind was only nominated to become administrator for the National Highway Traffic Safety Administration (NHTSA) two weeks ago by President Obama. Even so, Senate Democrats and Republicans would like for Rosekind to be confirmed before the end of the year. The Senate Commerce Committee has scheduled a Dec. 9 vote on nominations and the full Senate could vote on his nomination by the end of next week before Congress adjourns for the year.

    House Hearing on Children’s Health Insurance Program (CHIP)
    On Wednesday, the House Energy and Commerce Health Subcommittee held a hearing titled, "The Future of the Children’s Health Insurance Program." While Congress rarely proactively addresses fiscal deadlines, lawmakers at the hearing appeared to agree that CHIP funding should be allocated as soon as possible so that states can begin their budget planning early next year.
    The Affordable Care Act reauthorized CHIP through 2019 and federal funding for the program is set to expire on September 30, 2015. During the hearing, the Committee released 39 letters from state Governors and officials urging Congress to extend the program. However, some Republicans indicated they will seek changes to the program in order to pass additional costs on to consumers and states. Some suggested changes discussed during the hearing include: altering the program so it better complements private health insurance; increasing the program's cap on out-of-pocket costs; and restricting eligibility to solely target lower-income families.
    Additionally, Medicaid and CHIP Payment and Access Commission (MACPAC) Executive Director Anne Schwartz said her panel recommended that Congress extend CHIP for a transitional period of two years. She said Congress could use that time to "find a way to make sure there is integration of children into other forms of coverage and to make sure that coverage works well for children."

    Several patient advocates have called for CHIP to be reauthorized for four years. For further details on the hearing and a list of witnesses, please click here.

  • Weekly Update, November 21, 2014

    Congressional Calendar

    Both the House and the Senate are in recess for the Thanksgiving holiday.

    Executive Action on Immigration and Impact on Government Funding

    White House emergency spending requests are taking a back seat to a debate about whether to use a catch-all fiscal 2015 spending package to block executive actions on immigration. Over the next few weeks, appropriators and their staff will continue to negotiate a $1 trillion, wrap-up omnibus behind closed doors. Even if appropriators are forced to resort to a continuing resolution to fund agencies at current levels for fiscal 2015, additional emergency money for Ebola and the Islamic State could still ride on the legislation.
    The supplemental requests the White House submitted last week included $6.2 billion to fight the Ebola outbreak and $5.6 billion for operations against the Islamic State terrorist group. Please visit the ACEP website to view ACEP letters of support.
    Appropriators want to have the package negotiated by early in the week of Dec. 8 to give both chambers time to move it before Dec. 11, when the current stopgap expires. However, President Obama's announcement this week that he will use his executive powers to shield millions of illegal immigrants from deportation is causing many Republicans to urge their leaders to only consider a short-term bill.
    They argue this would give Congress the ability to intervene and potentially cut-off funding to implement the Executive Order.

    SGR Action in the Lame Duck Session – TAKE ACTION!

    ACEP along with a coalition of physicians and patient advocacy groups continue to push for repeal of the SGR before the new Congress convenes in January.
    The last short term patch enacted to prevent a cut to Medicare physician reimbursements will expire on March 31. Without congressional action, physicians will face a 21 percent cut.
    Talk of a permanent fix is still percolating among key members of Congress during the lame duck session, so it is imperative that we keep up the pressure to urge Congress to fix the SGR now before they recess for the year.
    We remain very concerned that the continued use of the Sustainable Growth Rate (SGR) formula to calculate Medicare physician reimbursement and the inherent instability of facing annual, and sometimes monthly, cuts will drive other physicians out of Medicare leaving the emergency department as the only viable alternative for seniors to access the nation's health care system.
    Furthermore, the U.S. faces a significant expansion of Medicare as 78 million baby boomers begin retiring and Medicaid is expected to double its enrollment in the next few years. America's emergency departments already treat more than 136 million patients a year and nearly one-fifth of those visits were by individuals ages 65 and older.
    Significant progress toward repealing the flawed SGR Medicare physician reimbursement formula will be lost if Congress fails to enact the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (H.R.4015/S.2000) before the end of the year.
    This bipartisan, bicameral legislation represents not only an end to the SGR, but the beginning to real reforms in the Medicare program. Almost no member of Congress opposes getting rid of the SGR. The challenge in recent years has been finding money in other programs, typically Medicare, to pay for the permanent fix. On November 14, the Congressional Budget Office (CBO) released a revised cost estimate the legislation (H.R.4015, S.2000). According to CBO, replacing SGR would cost $144 billion from 2015 to 2024. This is a notable increase from CBO’s $138 billion ten-year estimate in February, when the bills were introduced.
    If Congress leaves town and defers action until next year, then the bill will have to be reintroduced and the review process will start all over again. New congressional leadership, new committee chairmen and a new political environment make progress on the bill before the March 31 deadline questionable. Otherwise, physicians will be facing yet another cut of roughly 22% and the possibility of an 18th patch to keep that payment cliff from being implemented.

    Take Action and Call Your Legislators
    Use the AMA's Physicians Grassroots Network Hotline – (800) 833-6354–and urge your Member of Congress to go to their respective congressional leaders and insist that the SGR must be repealed before Congress adjourns. Waiting until next year threatens all that has been achieved to this point and introduces new and significant obstacles to finally repealing the fundamentally flawed SGR formula.

    Election News
    Physician member Rep. Ami Bera, who was supported by NEMPAC through campaign contributions and independent expenditures, was declared a winner in California District 7 this week. Rep. Jim Costa in California District 16 was also declared a winner in his re-election bid. AZ-02 remains too close to call, with Rep. Ron Barber (D-AZ) in a razor-close race with Republican Martha McSally. LA-05 and LA-06 will have a run-off election on December 6th to determine the winners, although both seats are expected to be held by Republicans. The current breakdown of the House is 244 Republicans and 186 Democrats.
    The Louisiana Senate race between Senator Mary Landrieu (D-LA) and Rep. Bill Cassidy (R-LA), a physician supported by NEMPAC, will result in a run-off on December 6. The current breakdown of the Senate is 53 Republicans, 44 Democrats and two Independents who typically caucus with Democrats.

    Senate Leadership in the 114th Congress
    Republicans
    Majority Leader: Mitch McConnell (KY)
    Majority Whip: John Cornyn (TX)
    Conference Chairman: John Thune (SD)
    Conference Vice-Chair: Roy Blunt (MO)
    Policy Committee Chairman: John Barrasso (WY)
    Republican Senatorial Campaign Committee Chairman: Roger Wicker (MS)

    Democrats
    Minority Leader: Harry Reid (NV)
    Minority Whip: Dick Durbin (IL)
    Caucus Vice-Chair and Policy Committee Chair: Chuck Schumer (NY)
    Caucus Secretary: Patty Murray (WA)
    Democratic Senatorial Campaign Committee Chair: Jon Tester (MT)
    Policy Committee Vice-Chair: Debbie Stabenow (MI)
    Policy Committee Strategic Policy Adviser: Elizabeth Warren (MA)
    Steering and Outreach Committee Chair: Amy Klobuchar (MN)
    Steering and Outreach Committee Vice-Chair: Jeanne Shaheen (NH)
    Chief Deputy Whip: Barbara Boxer (CA)
     
    House Leadership in the 114th Congress
    Republicans
    Speaker of the House: John Boehner (OH)
    Majority Leader: Kevin McCarthy (CA)
    Majority Whip: Steve Scalise (LA)
    Policy Committee Chair: Luke Messer (IN)
    Conference Chair: Cathy McMorris Rodgers (WA)
    Conference Vice Chair: Lynn Jenkins (KS)
    Congressional Committee Chair: Greg Walden (OR)
    Republican Study Committee Chairman: Bill Flores (TX)
    Senior Deputy Whip: Ann Wagner (MO)

    Democrats
    Minority Leader:
    Nancy Pelosi (CA)
    Minority Whip: Steny H. Hoyer (MD)
    Assistant Leader: James Clyburn (SC)
    Caucus Chairman: Xavier Becerra (CA)
    Caucus Vice-Chairman: Joseph Crowley (NY)
    Democratic Campaign Committee Chairman: Ben Ray Luján (NM)
    Steering and Policy Committee Co-Chairs: Rosa DeLauro (NY) and Donna Edwards (FL)
    Organization, Study, and Review Chairman: Karen Bass (CA)
    Policy and Communications Chairman: Steve Israel (NY)
    Senior Chief Deputy Minority Whip: John Lewis (GA)
    Chief Deputy Minority Whips: G.K. Butterfield (NC), Diana DeGette (CO), Keith Ellison (MN), Jan Schakowsky (IL), Kyrsten Sinema (AZ), Debbie Wasserman Schultz (AZ), Peter Welch (VT)
    Congressional Black Caucus Chair: G. K. Butterfield (NC)
    Congressional Hispanic Caucus Chair: Linda Sánchez (CA)
    Congressional Progressive Caucus Co-Chairs: Raúl Grijalva (AZ) and Keith Ellison (MN)

    Congressional Hearings
    On Tuesday, CDC Director Thomas Frieden testified before the House Energy and Commerce Committee Oversight and Investigations Subcommittee in what has become a regular occurrence since the Ebola virus spiraled into an epidemic in West Africa this summer. Seeing new clusters of Ebola patients in Mali, the CDC established a new requirement this week that anyone traveling from that country to the United States must follow the same screening protocols as those from Sierra Leone, Guinea and Liberia. To view more details on the hearing, please click here.

    On Tuesday the House Foreign Affairs Africa, Global Health, Global Human Rights and International Organizations Subcommittee held a hearing titled “Fighting Ebola: A Ground-Level View;” a list of witnesses can be found here.

    Also on Tuesday, the House Veterans’ Affairs Committee held a hearing regarding the VA’s Longstanding Information Security Weaknesses which are Increasing Patient Wait Times and Allowing Extensive Data Manipulation; a list of witnesses can be found here.

    On Wednesday, the Health Subcommittee of House Energy and Commerce Committee held a hearing titled "Examining Medical Product Development in the Wake of the Ebola Epidemic;" a list of witnesses can be found here.

    Also this past Wednesday, the Senate Health, Education, Labor and Pensions Committee marked up pending health legislation and labor nominations, including S.2917--Adding Ebola to the FDA Priority Review Voucher Program Act and H.R.669--Sudden Unexpected Death Data Enhancement and Awareness Act. For additional details, please click here.

    The House Science, Space and Technology Oversight Subcommittee held a hearing on Wednesday titled “The Role of the White House Chief Technology Officer in the HealthCare.gov Website Debacle;” a list of witnesses can be found here.
      
    The Senate Homeland Security and Governmental Affairs Committee on Wednesday held a hearing titled “Preparedness and Response to Public Health Threats: How Ready Are We?” a list of witnesses can be found here.

    The Senate Veterans' Affairs Committee held a hearing titled “Veterans' Mental Health and Suicide;” a list of witnesses can be found here.

    Also on Wednesday, the House Veterans’ Affairs Subcommittee on Health held a hearing on the following health bills: H.R.4720 (Medal of Honor Priority Care Act); H.R.4977 (COVER Act--related to mental health issues); H.R.5059 (Clay Hunt SAV Act--related to mental health and suicide prevention); H.R.5475 (to improve newborn care); and H.R.5484 (Toxic Exposure Research Act). Further details can be found here.

    On Thursday, the Primary Health and Aging Subcommittee of Senate Health, Education, Labor and Pensions Committee held a hearing titled "Why Are Some Generic Drugs Skyrocketing in Price?" a list of witnesses can be found here.

  • ACTION ALERT, November 19, 2014

    911 ACTION ALERT – CALL CONGRESS TODAY!

    URGE THEM TO REPEAL THE SGR BEFORE CONGRESS ADJOURNS


    Since the inception of the current system used to calculate Medicare physician reimbursements in 1997, the flaws in the underlying formula have been exacerbated. Just in the last few years, physicians faced a 21% cut in 2010, 30% cut in 2011, 27% cut in 2012 and 28% cut in 2013. Congress has intervened in each instance to delay these cuts, but it creates an even greater debt the following year. Clearly, this path is unsustainable.

    As emergency physicians, we have no choice regarding our participation in Medicare. We remain very concerned that the continued use of the Sustainable Growth Rate (SGR) formula to calculate Medicare physician reimbursement and the inherent instability of facing annual, and sometimes monthly, cuts will drive other physicians out of Medicare leaving the emergency department as the only viable alternative for seniors to access the nation's health care system.

    Furthermore, the U.S. faces a significant expansion of Medicare as 78 million baby boomers begin retiring and Medicaid is expected to double its enrollment in the next few years. America's emergency departments already treat more than 136 million patients a year and nearly one-fifth of those visits were by individuals ages 65 and older.

    Significant progress toward repealing the flawed SGR Medicare physician reimbursement formula will be lost if Congress fails to enact the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (H.R.4015/S.2000) before the end of the year. This bipartisan, bicameral legislation represents not only an end to the SGR, but the beginning to real reforms in the Medicare program.

    If Congress leaves town and defers action until next year, then the bill will have to be reintroduced and the review process will start all over again. New congressional leadership, new committee chairmen and a new political environment make progress on the bill before the March 31 deadline questionable. Otherwise, physicians will be facing yet another cut of roughly 22% and the possibility of an 18th patch to keep that payment cliff from being implemented.

    Take Action and Call Today

    Use the AMA's Physicians Grassroots Network Hotline – (800) 833-6354–and urge your Member of Congress to go to their respective congressional leaders and insist that the SGR must be repealed before Congress adjourns. Waiting until next year threatens all that has been achieved to this point and introduces new and significant obstacles to finally repealing the fundamentally flawed SGR formula.

  • Weekly Update, November 14, 2014

    Congressional Calendar
    Congress reconvened for a two-day congressional workweek to begin the lame duck session of the 113th Congress.
    Much of the week focused on new member orientation and leadership elections. Although we initially expected Congress to consider an omnibus appropriations measure that would contain all 12 spending bills for FY2015, and possibly tax extenders, terrorism risk insurance program reauthorization and judicial/State Department nominations, the agenda for the session is unclear. The Obama administration’s executive action on immigration has somewhat complicated any deals on funding the government beyond Dec. 11 when current short term funding expires.
    ACEP and other physician organizations are continuing to urge the House and Senate leadership to repeal the SGR before the end of the year as well. Congress passed another “patch” which runs through March 31, 2015. A permanent fix to the SGR would cost about $130 billion over 10 years, according to CBO. Congress continues to struggle with agreeing on the offset.
    Final adjournment is targeted for December 12.

    White House Meeting on Ebola
    ACEP President Michael Geradi, MD, FACEP participated in a meeting this week with Administration officials and health care groups to discuss joint initiatives to handle the Ebola crisis. Participants included Ebola Czar Ron Klain; Asst. Secretary for Preparedness and Response Nicole Lurie, MD; Acting Assistant Secretary of Health Karen DeSalvo, MD; Director for Medical Preparedness Policy at NSA Rick Hunt, MD, FACEP, and representatives from the AMA, AHA, and AAFP, among others. The participants discussed the need for regionalization, scientific-based quarantine, tiered centers for infectious disease treatment centers, flu vaccines, increased public and medical education regarding screening, and federal support for patient treatment and education.

    Ebola Supplemental Appropriations
    On October 24, ACEP submitted a joint letter from emergency and trauma organization stakeholders to House and Senate appropriators urging them to consider funding for regionalized emergency care, trauma system grants and the Hospital Preparedness Program (HPP) as a means to support the nation's emergency care providers identification and treatment of Ebola patients.
    Last week, the White House submitted its $6.2 billion emergency funding request to Congress to enhance the government's response to this disease domestically and internationally. The Obama Administration request provides $2.4 billion to the Department of Health and Human Services (HHS), $2 billion to the U.S. Agency for International Development (USAID), $127 million to the Department of State, $112 million to the Department of Defense, and $1.5 billion for a contingency fund ($751 million for HHS and $792 million for USAID and State).
    Within the HHS request, the Centers for Disease Control and Prevention (CDC) would receive $1.8 billion to support more than 50 Ebola Treatment Centers and procure personal protective equipment (PPE) for the Strategic National Stockpile, among other things. Furthermore, $333 million was requested for the Public Health and Social Services Emergency Fund, which would also support the regional Ebola treatment centers as well as the purchase of PPE for hospitals.
    The administration’s request for additional funding to help fight Ebola was also discussed in a Senate Appropriations Committee hearing on Wednesday titled, “U.S. Government’s Response: Fighting Ebola and Protecting America. ACEP and ENA submitted a joint statement/funding request to the committee in preparation for the hearing.

    Mid-Term Election Results
    The Alaska Senate race was called early Wednesday for Dan Sullivan, republican challenger to Sen. Mark Begich (D-AK). However, Sen. Begich has not conceded and thousands of ballots remain uncounted. A victory for Dan Sullivan brings republicans’ Senate pick-up to eight seats. If Rep. Bill Cassidy (R-LA), a physician, defeats Sen. Mary Landrieu (D-LA) in the Louisiana senate run-off on Dec. 6, Republicans will have 54 seats in the new Congress.
    Today, House Republican leaders are urging passage of legislation introduced by Rep. Cassidy that would approve the Keystone XL pipeline in hopes ofbolstering his election prospects. But Senate Democrats plan to do the same for Sen. Landrieu next week, lining up a vote on her identical legislation (S 2280).
    If that bill passes, the Senate will consider the House bill cleared for the president's signature. The President has not indicated whether he will veto or approve the legislation. Additionally in the uncalled House races; Republican Mark Assisni has conceded to Rep. Louise Slaughter (D) in NY-25; Rep. Julia Brownley (D-CA) claimed victory Wednesday over republican challenger Jeff Gorell in CA-26; Rep. Jim Costa (D-CA) has taken the lead in the most recent round of vote counting in CA-16; and Rep. Ami Bera (D-CA), a physician, has taken the lead in a close contest with republican challenger Doug Ose in the latest tally of mail- in ballots.

    House Approves Traumatic Brain Injury Bill
    Late Thursday afternoon, the House passed the ACEP-supported bill, S.2539, which amends the Public Health Service Act to authorize appropriations through FY2019 for traumatic brain injury (TBI) prevention and surveillance or registry programs. The Senate passed the bill in September and it is expected to be signed into law by the President in the coming weeks.

    Additional Co-Sponsors Added to ACEP EMTALA Liability Bill
    Reps. Mike Kelly (R-PA) and Greg Harper (R-MS) recently signed onto the ACEP-supported bill, H.R.36/S.961: “Health Care Safety Net Enhancement Act of 2013,” introduced by Rep. Charlie Dent (R-PA) in the House and Sen. Roy Blunt (R-MO) in the Senate.

    Congressional Hearings
    On Thursday, November 13, the House Veterans’ Affairs Committee held a hearing on Assessing the Implementation of the Veterans Access, Choice, and Accountability Act of 2014. Additional information can be found here.

    Also on Thursday, the House Foreign Affairs Committee held a hearing titled “Combating Ebola in West Africa: The International Response.” A list of witnesses can be found here.

    On Tuesday, November 18, the Oversight and Investigations Subcommittee of House Energy and Commerce Committee will hold a hearing titled "Update on the U.S. Public Health Response to the Ebola Outbreak.” For additional information, please click here.

    Also on Tuesday, November 18, the House Veterans’ Affairs Committee will hold a hearing on “VA’s Longstanding Information Security Weaknesses Continue to Allow Extensive Data Manipulation.” For additional information, please click here.

    On Thursday, November 19, the Health Subcommittee of House Energy and Commerce Committee will hold a hearing titled "Examining Medical Product Development in the Wake of the Ebola Epidemic.” For further information, please click here.

    Also on Thursday November 19, the House Veterans’ Affairs Subcommittee on Health will hold a hearing on the following health bills: H.R.4720 (Medal of Honor Priority Care Act); H.R.4977 (COVER Act – related to mental health issues); H.R.5059 (Clay Hunt SAV Act - related to mental health and suicide prevention); H.R.5475 (to improve newborn care); and H.R.5484 (Toxic Exposure Research Act). More information about the bills and hearing can be found here.

  • Weekly Update, Election Edition, November 7, 2014

    WEEKLY UPDATE – SPECIAL ELECTION EDITION

    2014 Mid-Term Election Report

    ACEP Members Re-Elected to the 114th Congress
    Dr. Joe Heck (R-NV)
    Dr. Raul Ruiz (D-CA)

    After many long and expensive months of difficult campaigns in key states, Americans voted to transfer power in the Senate and increase the Republican majority in the House of Representatives to its largest since 1928, further complicating President Obama’s final two years in office. Most of the GOP gains in the House came from solidly Democratic seats that President Obama easily carried two years ago.
    ACEP members running for re-election to Congress fared well with Rep. Joe Heck (R-NV) winning re-election to a third term with a decisive 61-36 margin over challenger Erin Bilbray (D). Rep. Raul Ruiz was elected to serve his second term in Congress, defeating challenger Brian Nestande (R) by a margin of 53-47.
    Both ACEP members were supported by ACEP’s political action committee, the National Emergency Medicine PAC (NEMPAC) with direct contributions to the campaign and through independent expenditures in the form of television and radio ads and direct mail. An independent expenditure is a political activity intended to assist or oppose a specific candidate for office that is done without the coordination or direct knowledge of the candidate. Additional information on NEMPAC’s participation in the 2014 elections is available on the NEMPAC website.

    Senate Highlights
    Republicans needed to win six net seats in order to take control of the Senate for the first time since 2007. Going into election day, there were 13 competitive seats impacting the potential change – Republicans needed to win nine of them to attain the 51-seat majority. Republican had several advantages on their side in this election, notably the president’s poor job approval rating and fewer seats to defend. Of the four targeted purple-state Senate races, Republicans picked up three, and a fifth in Virginia remains undecided. In Colorado, GOP Sen.-elect Cory Gardner comfortably defeated Sen. Mark Udall, in part thanks to besting the GOP's traditional performance among Hispanic voters in the state. In Iowa, Republican Joni Ernst comfortably defeated Democrat Bruce Braley, winning by a 7-point margin in a state that Obama carried twice. In battleground North Carolina, the favorable Republican environment trumped the Democratic ground game, with Thom Tillis defeating Sen. Kay Hagan by 2 points.

       Democrat    Republican   Independent 
     Previous Lineup 53 45 2
     Post-Election 43 (-7) 52 (+7) 2

    The winners in Louisiana and Alaska have not been determined. Louisiana will hold a run-off on Dec. 6 and Alaska could take until Nov. 18 to count all ballots. Sen. Mark Warner (D) declared victory in Virginia but challenger Ed Gillespie is within the 1-point recount margin and has not conceded.

    New Senators
    (highlighted names supported by NEMPAC)
    Gary Peters (D-MI)
    Tom Cotton (R-AR)
    Cory Gardner (R-CO)
    David Perdue (R-GA)
    Joni Ernst (R-IA)
    Steve Daines (R-MT)
    Ben Sasse (R-NE)
    Thom Tillis (R-NC)
    James Lankford (R-OK)
    Michael Rounds (R-SD)
    Shelley Moore Capito (R-WV)

    House Highlights
    Republicans won a total of at least 243 seats in the House, their largest majority since 1928. This expanded GOP majority in the House means that SpeakerBoehner (R-OH) will have an easier time passing legislation in the House without Democratic support. Republicans will also have an easier time holding on to their majority in future elections.

       Democrat  Republican  Vacant
     Previous Lineup 233 199 3
     New House:
     (13 Undecided)
    243 (+13) 179 (-13) 3

    Undecided/Uncalled Races
    (NEMPAC supported candidates are highlighted):

    AZ02 – Rep. Ron Barber (D) vs. Martha McSally (R)
    CA07 – Rep. Ami Bera (D) physician vs. Doug Ose (R)
    CA09 – Rep. Jerry McNerney (D) vs. Tony Amador (R)
    CA16 – Rep. Jim Costa (D) vs. Johnny Tacherra (R)
    CA17 – Rep. Mike Honda (D) vs. Ro Khanna (D) – Runoff between two Ds
    CA26 – Rep. Julia Brownley (D) vs. Jeff Gorell (R)
    CA31 – Pete Aguilar (D) vs. Paul Chabot (R)
    CA52 – Rep. Scott Peters (D) vs. Carl DeMaio (R)
    LA05 – Jamie Mayo (R) vs. R. Abraham (R) – Runoff, seat will remain R
    LA06 – Edwin Edwards (R) vs. Garret Graves (R) – Runoff, seat will remain R
    MD06 – Rep. John Delaney (D) vs. Dan Bongino (R)
    NY25 – Rep. Louise Slaughter (D) vs. Mark Assini (R)
    WA04 – Clint Didier (R) vs. Dan Newhouse (R)

    For comprehensive information on the 2014 elections, please go to CQ/Roll Call election coverage.

    HR. 36/S.961 Co-Sponsor Survival
    Of the 88 House and Senate co-sponsors of ACEP’s legislation, the “Health Care Safety Net Enhancement Act” (liability protection for EMTALA related services), twelve will not be returning to Congress due to retirements or defeat. One House co-sponsor will now serve in the Senate, Sen.-elect Shelley Moore Capito (R-WV) and another, Rep. Bill Cassidy (R-LA), may be elected to the Senate in a December run-off.

    Physician Members and Candidates
    There were 20 physicians serving in the 113th Congress but not all will return. Twelve physicians were re-elected: Reps Dan Benishek (R-MI), Charlie Boustany (R-LA), Larry Bucshon (R-IN), Michael Burgess (R-TX), Scott DesJarlais (R-TN), John Fleming (R-LA), Andy Harris (R-MD), Joe Heck (R-NV), Jim McDermott (D-WA), Tom Price (R-GA), Phil Roe (R-TN), and Raul Ruiz (D-CA). In addition, Sens. John Barrasso (R-WY) and Rand Paul (R-KY) will return as they were not up for re-election this cycle.
    The outcome of the races of two other physicians is unclear at this point. Rep. Ami Bera’s (D-CA) race has not been called and Rep. Bill Cassidy (R-LA), will be in a run-off on December 6 for the Louisiana Senate seat.
    Two physicians in Congress, Reps. Phil Gingrey (R-GA) and Paul Broun gave up their House seats to run for the GA Senate and were defeated in the primary. Del. Donna Christensen (D-VI-AL) and Sen. Tom Coburn (R-OK), an ob-gyn, retired.
    Eighteen physicians ran who were not currently serving in Congress. None of these physicians won – so there are no new physician members of congress. NEMPAC supported five of these candidates. So the new Congress will have 14 physician members with the possibility of 16 if Drs. Bera and Cassidy are successful.
    Two dentists, Reps. Paul Gosar (R-AZ) and Mike Simpson (R-ID), were also re-elected, and another dentist, republican candidate Dr. Bruce Babin, was newly elected to represent TX-36.

    Changes in Congressional Leadership and Committee Chairs
    Senate Minority Leader Mitch McConnell (R-KY) won a tough re-election race on Tuesday and unless something extraordinary happens, will lead the new Senate majority in January, as there is no sign of a real challenge from another member. With races still undecided in Virginia and Alaska and a run-off scheduled in Louisiana, Republicans could potentially hold a 55-seat majority.
    In recent interviews, Sen. McConnell indicated several procedural changes a Republican majority would bring to the Senate including reestablishing an emphasis on the committee process for reviewing legislation, an open amendment process, and a restored Friday work day for the Senate. Returning to an open amendment process would be a major reversal of the way Majority Leader Harry Reid (D-NV) has been running the Senate as he allowed very few Republican amendments to make it to the floor.
    One rule that Sen. McConnell is not likely to change is invocation of the “nuclear option” which allows approval of executive branch nominees by a simple majority rather than a 60-vote threshold. Many of Sen. McConnell’s Republican colleagues have state this lower level would presumably benefit Republican presidents one day.
    Sen. McConnell is expected to push strongly for a return to the regular appropriations process, whereby the House and Senate Appropriations committees pass 12 separate funding bills and then agree upon the details in conference—something Congress has not done since 1994. That process can begin immediately when Republicans take power in January, with all 12 bills due to the president's desk by Sept. 30, 2015. The return to a regular committee and appropriations process will require Republicans to take more difficult and frequent votes. In the past year, Sen. Reid’s strategy seemed to protect Democrats from casting those types of votes.
    The Senate will also have 20 new committee chairs due to the change in majority. It is expected that Sen. Orrin Hatch (UT) will chair the Finance Committee. In the Senate, HELP Committee, Sen. Lamar Alexander (TN) is currently ranking member, however, Sen. Mike Enzi (WY) still has a few years that he could serve as the chairman if he chooses to push his seniority on the committee. All three are veteran members of Senate who seem willing to compromise, adhere to committee process, and actually legislate.
    The House leadership on both the Republican and Democratic side is not expected to change with no discernible challenges to either Minority Leader Nancy Pelosi (D-CA) or Speaker John Boehner (R-OH). Several chairmanships will change in the House due to term limits and retirements. Rep. Paul Ryan (R-WI) is expected to become the next chair of the House Ways and Means Committee (former chair Dave Camp retired) and Rep. Tom Price (R-GA), a physician, is likely to become the next chair of the Budget Committee. Rep. Fred Upton (R-MI) will continue as chair of the Energy and Commerce Committee, although the committee will see a new ranking member with the retirement of Rep. Henry Waxman (D-CA). The two contenders for that post are Reps. Frank Pallone (D-NJ) and Anna Eshoo (D-CA).

    Lame Duck Session
    Both the House and Senate are scheduled to return to Washington, DC on Nov. 12 to begin the lame-duck session. Sen. McConnell and congressional leaders will meet at the White House on Friday to discuss several issues facing the lame-duck and then the new Republican-led Congress. Most likely at the top of the list is passage of a funding bill to keep the government open through September of next year, freeing up the calendar to take on other issues like a GOP budget and a long-term highway bill. Congress could also try to clear a host of lapsed business tax provisions and renew a government-backed program that helps insurance companies protect against terrorist attacks. Sen. Reid may push to confirm a new attorney general with Eric Holder's impending retirement.

    The New Congress
    Next year, under their new two-chamber majority, Senate Republicans may address issues such as approval of the Keystone XL pipeline, a repeal of the Affordable Care Act's medical-device tax, free-trade agreements, and a number of House-passed jobs bills that have languished in the Senate this Congress.
    A concern for Democrats going into 2015 is the possibility of a reconciliation bill—a process by which a simple majority can pass legislation after a limited debate and that has special procedural protections against a Senate filibuster. Reconciliation bills, which are generally formed by the Budget Committee and can only be used once per year, are intended to be limited to budgetary issues, but have been used much more expansively in the past, including passage of the Affordable Care Act in the Senate. They are still subject to a presidential veto.
    But the Republican majority will have a narrow window next year to get things done before the presidential primary season starts. Sen. McConnell will have to contend with fellow Republican Sens. Ted Cruz of Texas, Rand Paul of Kentucky, and Marco Rubio of Florida--all of whom are considering running for president in 2016.

    Health Care
    The first order of business may be a formal vote to repeal the ACA followed by more realistic efforts to modify the law. With Republicans in control of the Senate, expect votes on full replacement plans such as those put forth by the Republican Study Committee and Coburn-Hatch-Burr. After that, narrower measures aimed at repealing the medical device tax, re-defining full-time work as 40 hours per week and repealing the Independent Payment Advisory Board (IPAB) are likely. Efforts to further delay the employer mandate are also possible.
    The new Congress will need to deal with the SGR again as well. There was a bi-partisan, bi-cameral agreement earlier this year to repeal the SGR and replace it with a performance - based payment system. Six key committees and both House and Senate agreed to the permanent fix– the House passed the fix but it was not taken up by the Senate. Instead Congress passed another “patch” which runs through March 31, 2015. A permanent fix to the SGR would cost about $140 billion over 10 years, according to CBO. Congress continues to struggle with agreeing on the offset.

    ACEP Advocacy with the New Congress
    As the 2014 congressional elections began to take shape, we heard from ACEP members around the country and from leaders in our state chapters about candidates in their states and home districts who were worthy of consideration by the NEMPAC Board of Trustees. More than 150 ACEP members hosted ED visits for congressional candidates to educate them on issues of particular concern to EM physicians and patients, interviewed and educated candidates, attended fundraisers in their home districts, and presented NEMPAC checks to candidates.
    In the upcoming months before the 114th Congress convenes, ACEP staff in the Washington DC office will begin a campaign to meet as many newly elected members as possible and will be working to set up introductory meetings back home with ACEP members either through Emergency Department visits or more informal coffees. If you are interested in meeting with your Member of Congress in the next few months, please contact Jeanne Slade in the ACEP office at jslade@acep.org. We will provide you with talking points and materials to help you educate your legislator on issues of importance to emergency medicine.

  • Emergency Physicians on Capitol Hill, Leadership & Advocacy Conference 2017

    Check out the the LAC17 photo gallery highlights

    View Gallery

  • Latest Video

    See ACEP President Dr. Jay Kaplan's live "Call to Action" with legislators on Capitol Hill during the LAC16.

  • Contact Us

    Have any feedback for us? We'd love to hear it. Contact us with any questions, comments, or concerns you may have.

    Send a Message