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

Medicare Reimbursement

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

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

Pain Management, Rural Hospitals, and More

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

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

Looking Ahead: Key Issues Continue into 117th Congress

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