Part of the ACEP mission is to expand and strengthen state advocacy. Chapter initiatives are making a positive impact on emergency physicians in their own communities with actions that often have implications for the entire specialty. Here, we highlight some of the key state efforts this year.

California Scores Historic Reimbursement Win

After hundreds of California ACEP members contacted Governor Newsom and state legislators, a long-overdue increase to Medi-Cal reimbursement rates was included in the state’s budget.

Starting in 2025, $200 million will be devoted annually to increase reimbursement rates to emergency physicians. The increase will move reimbursement rates from between 55 and 60 percent of Medicare reimbursement to 80 percent.

Medi-Cal reimbursement rates have not increased in 20 years, until now. California ACEP advocacy led to emergency medicine being the only physician specialty specifically delineated in the budget bill.

“We are thrilled that these changes will improve access to care for Medi-Cal recipients,” said Valerie Norton, MD, FACEP, president of California ACEP. “The long overdue increase should significantly impact emergency physicians who serve a high proportion of vulnerable patients—this is a stunning success.”

There will be other increases to Medi-Cal, including an annual appropriation of $1.38 billion for primary-care rate increases, $1.15 billion for specialty-care rate increases, $500 million for hospital emergency-department reimbursement, at least $500 million for family planning and reproductive-health care, and $600 million for behavioral-health facilities, including some for new inpatient psychiatric beds.

Minnesota Calls for System Changes to Address Boarding Crisis

Minnesota ACEP is teaming with the Minnesota Medical Association to offer a series of recommendations to address the boarding crisis in their home state.

The recommendations, released in June, were outlined in a detailed statement that includes suggestions to address the many contributing factors, mitigate exacerbating circumstances, and develop solutions focused on patients with psychiatric diagnoses collaboratively with partners across the care continuum.

Task force co-chair Drew Zinkel, MD, senior medical director of emergency medicine at the University of Minnesota in Minneapolis, and past president of the Minnesota Chapter of the American College of Emergency Physicians: “The recommendations that our task force developed offer up a game plan on addressing this complex issue. It’s a big lift but desperately needed.”

Read the Minnesota ACEP and Minnesota Medical Association recommendations in its joint statement at acep.org/MNboarding.

Closing the Road to Alternative Certification in Puerto Rico

Senate Project 1134, touted as a way to alleviate the physician shortage in Puerto Rico, would have created an alternative pathway to a certification in emergency medicine, avoiding the training and certification standards supported by ACEP and the American Board of Emergency Medicine.

One proposal in the legislation was to create an alternative pathway for general practitioners to become certified as emergency physicians based on 10 years working in an emergency department, and not based on completion of the training, residency, and board-certification programs required for emergency physicians. ACEP is a strong proponent of the pathway to board certification through training and residency with a certification issued by the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM).

Puerto Rico ACEP responded with a comprehensive advocacy campaign that included grass roots, coalition outreach, direct lobbying, and earned media to push against the legislation. Puerto Rico ACEP and national ACEP sent individual letters to the senate president and the presidents (chairs) of the senate and assembly health commissions (legislative committees) formally expressing opposition to the legislation. Cesar Andino-Colon, MD, FACEP, raised awareness of the problems in the legislation, participating in several public-affairs television programs and amplifying the reach of those appearances through social media.

ACEP reached out for national organizational support, including to the American Board of Medical Specialties (ABMS) among others. The outreach generated additional advocacy and letters of opposition. The ABMS provided additional support and guidance to ACEP’s public-relations staff on hiring a contract lobbyist. ACEP was able to coordinate a written public statement by a newly formed coalition of 38 medical specialties and subspecialty organizations with the Puerto Rico College of Physician and Surgeons, and national organizations abroad sent statements that the chapter was able to make public strategically in coordination with the organizations.

The groundswell of opposition to the legislation led to the bill being pulled from consideration before a hearing could be held in the senate’s health commission. Read more details at acep.org/puerto-rico-win.

Indiana Bill Requires Hospital EDs to Have Physician Onsite

Signed into law this May by Indiana Governor Eric Holcomb, SB 400 is a comprehensive health care bill that includes reforms to physician credentialing and prior authorization, among other items. The language proposed by Indiana ACEP and passed into law requires a hospital with an emergency department to have at least one physician on site and on duty who is responsible for the emergency department at all times.

Indiana ACEP was directly involved in the legislative process from the start. Emergency physician expertise and support was instrumental in developing the language and rallying support for the new law.

“We are gratified to see that the Hoosier state recognizes the importance of physician-led care and look forward to continuing this very important work of advocating for our specialty,” said Indiana ACEP President Lindsay Zimmerman, MD, FACEP.

Dr. Zimmerman and Dan Elliott, MD, provided testimony to support the bill that can be viewed at acep.org/indiana-victory.

Trained Security Now Required in Virginia Emergency Departments

Virginia law now requires trained security in every emergency department and Virginia ACEP advocacy helped make that possible.

The new law requires off-duty police officers or security personnel in the emergency department around the clock. They will have training in conflict resolution and de-escalation, and have the ability to physically restrain unruly patients, family members, or other individuals in the ED. Part of the new law requires every Virginia emergency department to create a security assessment and risk plan.

Virginia ACEP supported this effort the entire way through. Violence prevention was a centerpiece of Virginia ACEP’s EM Advocacy Day in January, when chapter members met with state legislators to share stories of workplace violence and help make sure this bill received strong bipartisan support.

Hospitals will undergo a security-risk assessment that includes trauma-level designation, overall volume, volume of psychiatric and forensic patients, incidents of violence against staff and level of injuries sustained from such violence, and prevalence of crime in the community.

Federal Judge Strikes Down Virginia Downcoding

Virginia ACEP was involved in asking the Virginia Department of Medical Assistance Services and Centers for Medicare and Medicaid Services to remove harmful “downcoding” provisions from the Virginia budget. In April, a federal judge ruled the Virginia downcoding policy is not in line with federal law and the prudent layperson standard and should be removed—a win for emergency physicians.

Since 2020, Virginia’s budget had automatically cut Medicaid reimbursements for emergency department visits that are on a list of 800 emergency conditions for Medicaid patients. The Department of Medical Assistance Services plans to pay for the downcodes that have occurred since the ruling.

Wisconsin Insurance Commissioner Sides with Emergency Physicians

Molina Healthcare of Wisconsin rolled out a policy earlier this year that denied payment for critical-care services when the patient was subsequently discharged from the hospital without being admitted. ACEP and Wisconsin ACEP submitted a complaint to the state insurance commissioner in March detailing concerns.

Our letter outlined the importance of critical-care services and the numerous instances when the initial encounter does not result in a patient being admitted. On May 18th, the insurance commissioner’s office sided with ACEP and ordered Molina to stop denying critical-care claims for payment under their policy.

Contact Adam Krushinskie, ACEP state legislative affairs director, with your state advocacy success stories. Learn more about recent achievements and opportunities to get involved in state advocacy by visiting acep.org/stateadvocacy.