December 14, 2024

ACEP in Washington DC

Congress Continues Working to Wrap Up Year-End Negotiations

Congressional leaders continue working on a bipartisan agreement for an end-of-year health package, hoping to address a number of unresolved health care priorities before the end of the 118th Congress. Democrats and Republicans have been trading offers for several weeks on a deal that would reauthorize a slew of health care programs, extend a number of vital Medicare provisions, and include some relief from the 2.83 percent cut for Medicare physician reimbursements that will go into effect on January 1, 2025, without congressional intervention. As of this writing, reports have indicated that the potential package is broader than anticipated, but the bill text is still not final, and things could change throughout the weekend. 

The current deal centers on several ACEP priorities, including a five-year reauthorization of the SUPPORT Act, the comprehensive federal law aimed at combating the opioid epidemic, a one- to two-year extension of the Pandemic and All-Hazards Preparedness Act (PAHPA), a two-year extension of existing telehealth flexibilities, and relief for most of the impending Medicare physician payment cuts. Other provisions may also be included, such as new rules regarding prior authorization utilization in Medicare Advantage plans.

Negotiations continue on the overall scope and scale of the package, particularly on how to pay for the costs of the provisions. Further details are expected sometime this weekend with Congress rapidly approaching a government funding deadline on Friday, December 20, leaving only a narrow window to get several large legislative issues resolved before the 118th Congress adjourns. 

We thank you for your advocacy on many of these issues throughout the year and will keep you informed of the progress of this package as negotiations continue.

ACEP Responds to Congressional RFI on MOUD Barriers

On Wednesday, ACEP submitted a comprehensive response to a recent request for information (RFI) issued by Reps. Paul Tonko (D-NY) and Mike Turner (R-OH) regarding industry-wide efforts to eliminate barriers to medications for opioid use disorder (MOUD). The RFI highlighted the critical need to expand access to treatments like buprenorphine, which can help reduce overdose mortality. 

In our response, ACEP emphasized its ongoing efforts to educate emergency physicians about the Mainstreaming Addiction Treatment (MAT) Act, the ACEP-supported federal law that repealed the redundant “X-waiver” formerly required to prescribe buprenorphine, as well as continuing work to reduce stigma around MOUD through webinars, clinical guidelines, and public awareness campaigns. ACEP’s response also advocated for increased reimbursement rates, streamlined regulations, and greater flexibility for MOUD prescribing in emergency departments.

The response also highlighted several specific ACEP legislative priorities, including:  

• BUPE for Recovery Act: Legislation to temporarily exempt buprenorphine from the DEA’s Suspicious Orders Report System (SORS) during the opioid public health emergency to improve access.
• Hospitals as Naloxone Distribution Sites (HANDS) Act: Ensure naloxone is available at no cost under Medicare, Medicaid, and TRICARE to prevent opioid overdose deaths by eliminating financial barriers to its distribution in hospitals.
• Preventing Overdoses While in Emergency Rooms (POWER) Act: Reauthorize and fund programs to equip emergency departments with tools and protocols for initiating treatment for opioid use disorder (OUD) and transitioning patients to long-term care.
• Modernizing Opioid Treatment Access Act: Allow pharmacies to dispense methadone for OUD and expand prescribing authority to board-certified addiction medicine or psychiatry physicians outside of opioid treatment programs (OTPs).
• Emergency Department Alternatives to Opioids (ALTO) Program: Fully fund and expand grants to help hospitals implement evidence-based non-opioid pain management protocols.
• Telehealth Flexibility for MOUD Prescriptions: Make permanent the temporary exceptions under the Ryan Haight Act to allow prescribing of controlled substances like buprenorphine via telehealth without requiring in-person evaluations.  

Regulatory Update

HHS ONC/ASTP Releases Health Data, Technology, and Interoperability: Trusted Exchange Framework and Common Agreement (TEFCA) (HTI-2) Final Rule

The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) within HHS released a Health Data, Technology, and Interoperability: Trusted Exchange Framework and Common Agreement (TEFCA) (HTI-2) final rule Wednesday, with many proposed policies that were included in the HTI-2 proposed rule (first released in July) still under further review and development. The final rule amends information blocking regulations by including definitions related to the TEFCA Manner Exception. The final rule also implements provisions related to TEFCA aimed at supporting reliability, privacy, security, and trust within TEFCA. Lastly, the final rule includes corrections and updates to current regulatory provisions of the ONC Health IT Certification Program.

ACEP previously commented on the proposed rule, including comments on the United States Core Data for Interoperability version 4 (USCDIv4), public health data exchange, and information blocking provisions, which can be found here.

ACEP Comments on Proposed Changes to 2025 Leapfrog Hospital Survey

On Thursday, we submitted our response to the Leapfrog Group's proposed changes to their 2025 Hospital Survey, which includes a subsection of the Patient Safety section with the addition of two measures associated with emergency department (ED) boarding. The Survey “collect[s] data that ensures [employers and payors] are receiving the best possible value for their employees' health benefits and to drive giant leaps forward in hospital safety, quality and transparency.”

ACEP appreciates the Leapfrog Group’s acknowledgment of the patient safety risks associated with ED boarding of admitted patients and commends the Group for proposing collection of this information. We offer comments on the measure specifications, the option of measure reporting, and potential enhancements of data collection and reporting.

NEMPAC/Political Update

If you have not yet made your annual contribution to the National Emergency Medicine PAC (NEMPAC), please consider helping us reach our goal of $1 million by year end. Every donation makes a difference! Our involvement in the 2024 congressional races was critical in helping to elect candidates who are willing to listen and work on behalf of the interests of emergency medicine and patients.

Members of the 119th Congress will be sworn in on January 3 and NEMPAC will need the resources to continue educating new members and champions and friends. The first hundred days of the new Congress promises to be action packed and NEMPAC must continue to have a strong voice on behalf of your practice and patients. Please click here to make your donation.

For more information about NEMPAC in the 2024 Elections, please go to the NEMPAC website.

State Updates
State Legislation Tracked by ACEP

To share legislative activity happening in your state, contact Adam Krushinskie. Check out the state legislation that is currently identified and being tracked by ACEP:

• Scope of Practice
• Violence Against Healthcare Workers
• ED Boarding and Crowding
• Private Payer Insurance
• All Other Bills

ACEP Advocacy Leaders Program

ACEP's Advocacy Leaders Program supports emergency physicians interested in taking their engagement and advocacy with federal legislators and staff to the next level. If you are interested in joining or already have a relationship with a federal legislator, complete this short form to receive more information.