As Congress works to craft a broad year-end legislative package, we need your help to ensure the “Mainstreaming Addiction Treatment (MAT) Act” is included in any end-of-the-year deal. This bill will help increase access for emergency physicians to provide buprenorphine, lifesaving medication to help opioid use disorder (OUD) patients, and decrease the stigma associated with treatment. It is ACEP’s understanding that the MAT Act is well-positioned as these discussions take shape, and we need your help to keep up the momentum and make certain this bill becomes law before the end of the congressional session.

Urge your federal legislators now to push for inclusion of the MAT Act in any year-end legislative package.

The MAT Act (H.R. 1384/S. 445) would remove outdated federal requirements for a separate waiver to dispense buprenorphine, allowing all health care practitioners with a standard controlled medication license to prescribe buprenorphine for OUD. Removing the waiver would increase access to evidence-based, lifesaving treatment with buprenorphine as part of medication-assisted treatment (MAT) protocols.

This legislation has strong bipartisan support and was passed by the House of Representatives earlier this year in an overwhelming 402-20 vote, as part of the Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666). Congress only has a few weeks left to finish legislative business, and we need to capitalize on this opportunity to get this bill signed into law.

Emergency physicians could once again face drastic reductions to Medicare payments at the end of the year due to sequestration and Medicare’s “budget neutrality” requirements – a more than 10% cut that would jeopardize patient access to lifesaving emergency care. 

Click here to quickly send a message to your Senators! And if you haven’t already, please also urge your Representative to co-sponsor the "Supporting Medicare Providers Act of 2022" (H.R. 8800).

In the House, Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) have introduced H.R. 8800, a bipartisan bill that provides an additional 4.42% to the Medicare Physician Fee Schedule (PFS) conversion factor for 2023 and acknowledges the necessity of long-term physician payment reform. While the list of House cosponsors of this bill continues to grow, in large part due to your advocacy, we also need the Senate to act before the end of the year to prevent these harmful cuts. 

As Congress approaches the end of the year, legislators need to hear from you – as an emergency physician on the front lines – that these cuts will further destabilize the health care safety net and threaten patient access to care. 

On Thursday, the Senate Finance Committee released its fifth and final discussion draft on mental health policies, aimed specifically at addressing the issue of mental health parity in Medicare and Medicaid and putting access to mental health services and substance use disorder (SUD) services at the same level as physical health care.

The discussion draft includes policies to:

• Strengthen the accuracy of provider directories in Medicare Advantage (MA) plans;
• Strengthen requirements in Medicaid for managed care organizations and states to maintain regularly updated provider directories that include, in part, information on accessing care from behavioral health professionals;
• Directing the Government Accountability Office (GAO) to conduct a study of the differences in enrollee cost-sharing and utilization management between behavioral and non-behavioral health services in MA and compared to traditional Medicare;
• Requiring Medicare to provide guidance to health care providers detailing the extent to which Medicare beneficiaries with SUD can receive partial hospitalization program services; and,
• Directing GAO to report on Medicaid payment rates for behavioral health services compared to medical and surgical services across a sample of states.

In communications with the Committee, including our response to the request for information (RFI) issued late last year, ACEP has expressed the need for mental health parity as well as the need for increased compliance and enforcement for insurers to provide accurate, up-to-date provider directories. ACEP is reviewing the draft and will provide comments and feedback to the Committee as appropriate.

The current continuing resolution (CR) to fund the government expires on December 16, just two weeks away.

The status of a wide variety of year-end priorities remains very unclear, as congressional leadership and committees continue working to find a path forward either through an omnibus appropriations package or another CR of as-yet undetermined length – potentially as long as through the remainder of the 2023 fiscal year. There is also a possibility of an additional week-long CR to give legislators a few more days to get a deal through before the Christmas holiday.

ACEP hopes to provide a more in-depth update on the status of a year-end package and our health care priorities next week as more details emerge. Our top priority remains averting a potential 10.5% Medicare payment cut on January 1, 2023. Other priorities include ongoing efforts on mental health and substance use disorder, including ensuring the Mainstreaming Addiction Treatment (MAT) Act is included in any year-end package. See the action alerts above or click here to help advocate for these priorities now!

On Wednesday, Senator Mike Braun (R-IN) filed official paperwork to run for governor of Indiana in 2024, opening up his Senate seat. Though he has not yet officially announced his candidacy, his staff confirmed to the press that he will make an official announcement soon. Sen. Braun was first elected to the Senate in 2018 after serving in the Indiana legislature. 

Among several other committees, Sen. Braun serves on the Senate Health, Education, Labor, and Pensions (HELP) Committee, which has jurisdiction over a significant portion of the congressional health care portfolio.

While still early, there are at least two current Indiana members of the House of Representatives reportedly interested in seeking the open Senate seat, including Rep. Jim Banks (R-IN) and Victoria Spartz (R-IN).

On November 28, the Center for Medicare and Medicaid Services (CMS) issued a memo directed to hospital leaders reminding them of their responsibility to “provide adequate training, sufficient staffing levels, and ongoing assessment of patients and residents for aggressive behavior and indicators to adapt their care interventions and environment appropriately.” In the memo, CMS references an April 2020 Bureau of Labor Statistics Fact Sheet that healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018, and states that “with appropriate controls in place,” workplace violence can be addressed. CMS reiterates that they “will continue to enforce the regulatory expectations that patient and staff have an environment that prioritizes their safety to ensure effective delivery of healthcare.”

On November 28, ACEP and the Emergency Department Practice Management Association (EDPMA) sent a letter to the Biden Administration expressing concern about the number of independent dispute resolution (IDR) claims being placed on hold, as well as the recent announcement that IDR fees (the fee that the arbitrator charges for the IDR process) will increase in 2023. The rationale for the increase is that arbiters are sorting through many more claims than expected, and in many cases, have to do a lot of work to determine whether the claim is eligible for the federal IDR process. In the letter, we argue that health plans are not providing the information they are supposed to provide, which would help make the process much more efficient. One solution to this (besides more enforcement, which we also argue for) is to require health plans to use certain Remittance Advice Remark Codes (RARCs) when providing the disclosures that are required along with the initial payment or notice of denial for out-of-network services under the No Surprises Act. These RARCs, which are currently optional, very clearly lay out whether the claim is subject to federal or state law and therefore would certainly help clear up a lot of confusion that is impeding the success of the federal dispute resolution process.

On November 23, ACEP responded to a proposed rule issued by the Department of Labor (DOL) that modifies the criteria used to determine whether a worker is an employee or an independent contractor under the Fair Labor Standards Act (FLSA). In ACEP’s response, we state that we appreciate the DOL’s effort to ensure that there is a fair process for determining whether an individual is deemed an employee or independent contractor. However, we believe it is important for the DOL to recognize the complexity of health care employment structures when issuing its finalized policies. Therefore, we request that in the final rule, the DOL specifically address the dynamic health care labor market and perhaps consider creating a stand-alone policy specific to health care that will ensure that health systems and providers have the flexibility to engage in contractual and employment arrangements that will best meet their needs and the needs of their communities.

The 2023 Merit-based Incentive Payment System (MIPS) performance year is the first year of a new reporting option called the MIPS Value Pathways (MVPs) – and the question is, should you partake in this alternative to Traditional MIPS? 

Read the Regs & TURKEY LEGS blog for ACEP’s analysis of MIPS reporting in 2023, including an assessment of the new MVP reporting option.

This is the third post in the series ACEP is doing with the Geriatric Emergency Department Collaborative (GEDC), as well as West Health and The John A Hartford Foundation. These posts delve into the concept of value-based care in emergency medicine. While the first two posts presented some challenges that emergency medicine still needs to overcome to move to value-based payment, this third post in the series explores how you can actually make that leap now into value-based care initiatives! 

Read the Regs & Eggs blog for a three-step approach, put together by folks at the GEDC and West Health, on how you can work with private payors to convert your fee-for-service payment contracts into value-based contracts.