EDPMA’s advocacy efforts keep our issues front-and-center with state legislators and regulators, Congress, CMS, CCIIO and other agencies. Click on the links to see our advocacy in action.
2024 Letters
EDPMA Comments on the CY 2025 Physician Fee Schedule Proposed Rule
On September 9, 2024, EDPMA commented on the CY 2025 Physican Fee Schedule and highlighted the unique practice of emergency medicine and EMTALA. We request that the telehealth services codes permanently add telehealth services codes for ED E/M visits, critical care services and other telehealth considerations. EDPMA urges CMS to add CQMs to the EM MVP. we also request changes to Part B payment and coverage policies, Medicare Shared Savings program requirements, Medicare Prescription Drug Inflation Rebate program and Medicare Overpayments. Read the letter here.
EDPMA Outlines Concerns About QPA Reliability to IDREs
On August 20, 2024, EDPMA forwarded the letter sent to the Departments and Congressional leaders urging them to issue immediate guidance to IDREs to ensure accurate calculations of the Qualifying Payment Amounts (QPAs). In our cover letter, EDPMA outlined our significant concerns about the reliability of the QPA.
EDPMA Comments on Medical Credit Reporting Proposed Rule
On August 9, EDPMA commented on the CFPB medical debt reporting proposed rule, Prohibition on Creditors and Consumer Reporting Agencies Concerning Medical Information (Regulation V) In our response, we highlighted the unique challenges of EMTALA on the delivery of emergency care by independent practicing emergency physicians. We further pointed out that 65% of aggregate emergency visit costs are at risk of underpayment. We asked the CFPB to impose a safe-harbor exception by allowing credit bureau reporting of medical debt incurred by commercially insured health plan beneficiaries for cost-sharing obligations on insurer/health plan adjudicated amounts of not less than $100 and no more than $1,000. Read the letter here.
EDPMA and ACEP Urge the Departments to Issue Immediate Guidance to IDREs to Ensure Accurate QPA Calculations
On July 29, 2024, EDPMA and ACEP urged the Departments to offer immediate guidance to IDREs on QPA calculations that lays out the reasons why QPAs could possibly be inaccurate and requires IDREs to consider the strong possibility that QPAs are inaccurate when rendering payment determinations. Read the letter here.
EDPMA and ACEP Urge Dept Guidance on QPA Reliability
July 29, 2024 – In light of the TMA III case and provisions NOT appealed by the administration, EDPMA and ACEP urge the Departments to issue immediate guidance that lays out reasons why QPAs could possibly be inaccurate and that requires IDREs to consider the strong possibility that QPAs are inaccurate when rendering payment determinations. Read the letter here.
EDPMA Responds to Senate Finance Committee White Paper on Physician Payment
On June 13,20234, EDPMA responded to the Senate Finance Committee white paper “Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B.” EDPMA highlights emergency care’s vulnerability to the downward trend in Medicare reimbursements and calls for the creation of an inflationary update and the modernization of budget neutrality requirements. Read our letter.
EDPMA Supports Ohio HB 452 to Support Hospital Violence Prevention Plans
On June 4, 2024, EDPMA urged the Ohio House Public Health Policy Committee to support HB 452 that focuses on the creation of hospital violence prevention plans, training and incident reporting and to ensure its swift passage. Read our letter.
EDPMA Responds to 2024 Measure Set Review
On May 31,2024, EDPMA commented on three measures being considered for removal from MIPS including adult sinusitis, CT utilization for minor blunt head trauma for patients 2-17 years old and 18+ years old. Read our comments.
EDPMA Supports Introduction of the EMTALA Preservation Act of 2024
On May 31,2024, EDPMA urged Rep. Diana Harshbarger (TN 1st District) to introduce the EMTALA Preservation Act of 2024 as innovative legislation to establish stand-alone, supplemental funding source for the delivery of EMTALA-related emergency care. Read our letter.
EDPMA Responds to Consolidation in Health Care Markets Request for Information (RFI)
On May 24, 2024, EDPMA responded to the information request from the Federal Trade Commission, Department of Justice and the Department of Health and Human Services on Consolidation of Health Care Markets highlighting that consolidation and private equity investment are two distinct issues. We further state that consolidation and private equity investment should not be the sole focus of this RFI. Instead, we believe that the optimization of quality and accessible care should be the goal of all healthcare policy reforms and that a clinicians’ ability to practice medicine should be free of interference from third parties. Read our RFI response.
EDPMA Addresses Chronic Down Coding in Six States
Some Managed Care Organizations (MCOs) are down-coding emergency department claims based on diagnosis codes listed in an auto-pay list unilaterally approved by the MCO. This practice contradicts with the published AMA CPT and CMS coding guidelines. threatens EMTALA and patient care. To call out this practice, EDPMA requested meetings with state Medicaid programs. On May 15, 2024, EDPMA met with the Iowa Department of Healthcare and Human Services. See our letters sent to regulators in Illinois, Indiana, Iowa, Nebraska, Texas and Missouri.
EDPMA Comment Letter to the Senate Finance Committee
On April 12, 2024, EDPMA submitted a letter to the Senate Finance Committee strongly urging a long-term fix to the Medicare Physician Fee Schedule including the creation of an annual inflationary update and the modernization of budget neutrality requirements. Read our letter.
On April 2, 2024, EDPMA and ACEP urged the Departments of Health and Human Services, Treasury and Labor to clarify that the “initial payment” has not been made until the date in which the practice is in possession of both the funds associated with the initial payment AND the 835 electronic remittance advice. We also urged the Departments to announce flexibilities in the No Surprises Act deadlines to allow time for our members to recover from the impact of the cyberattack. Read our letter.
EDPMA Advocates For Improvements in the Arbitration Process for Out-Of-Network Claims in Colorado
On March 28, 2024, EDPMA expressed its support for Senate Bill 24-163 which aims to improve the arbitration process for out-of-network health insurance claims by introducing a batching process. We believe this bill is a crucial step towards fostering a more efficient, cost-effective and harmonious resolution of out-of-network health insurance claims, allowing physicians to spend more time caring for patients rather than excess time fighting with insurers over proper payment. Read our letter.
On March 21, 2024, EDPMA urged the Georgia Department of Community Health to thoroughly review and reinforce compliance standards for Managed Care Organizations (MCOs) to prevent inappropriate down-coding of emergency medicine claims. We believe it is imperative that MCOs operating within their program do not impede emergency departments from fulfilling their legal obligations under EMTALA. Read our letter.
EDPMA’s Letter to the CT Human Services Committee Regarding House Bill 5459
On March 12, 2024, EDPMA addressed several concerns with Connecticut House Bill 5459 – An Act Increasing Rates of Medicaid Reimbursement for Certain Providers. These concerns include including emergency physicians when defining “select providers” and amend “physicians speciality services to include specified rate increases for emergency physicians. Read our letter.
On March 1, 2024, EDPMA urged the Department of Health and Human Services to provide opportunities to increase practice cash flow, to quantify the full impact of the cyberattack, to provide MIPS flexibilities and to increase outreach to physician practices, hospitals and revenue cycle management entities. Read our letter.
Change Healthcare Cyberattack: EDPMA Advocates on Capitol Hill
On March 1, 2024, EDPMA sent a note to 736 Capitol Hill staffers sharing the immediate and urgent impact due to Change Healthcare’s halt of operations because of their cyberattack. Read our note.
On February 26, 2024, EDPMA and ACEP urged Health and Human Services, and the Departments of Labor and Treasury to hold health plans accountable for violating the patient protections in the No Surprises Act.
EDPMA Supports Permanent Telehealth Policy Flexibilities
On February 21, 2024, EDPMA joined others to urge Congress to make permanent telehealth flexibilities well in advance of the December 31, 2024, deadline.
EDPMA Fights For Increased Medicaid Reimbursement For Emergency Physicians In Connecticut
On February 21, 2024, EDPMA urged the Appropriations Committee through written testimony to increase the allocation of funds for Medicaid rate reimbursement for emergency physicians in Connecticut.
EDPMA Comments on Equity of Emergency Care Capacity and Quality eCQM
CMS has contracted with Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) to develop a measure that captures variation in equity, capacity and quality of emergency care. The developers recently released for public comment a draft Equity of Emergency Care Capacity and Quality electronic clinical quality measure (eCQM), which aims to capture established outcome metrics that quantify capacity and access of care in an emergency department (ED). This measure, which was developed for potential future use under the Hospital Outpatient Quality Reporting Program, targets patients of all ages and all visits that occur at an ED, but evaluates two separate cohorts: patients without behavioral health disorders and patients with behavioral health disorders. During a recent public comment period, EDPMA submitted feedback in support of the measure, but requested that the developers ensure that the measure does not hold EDs accountable for delays in care due to factors outside of the ED’s direct control.
EDPMA endorses the reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act.
On February 6, 2024, EDPMA endorses the reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act. This is a four-year reauthorization of bipartisan legislation that established grant programs and a national campaign to prevent suicide, burnout, and mental health conditions among healthcare providers. A high-level summary can be found here. The bill was enacted following the suicide of Dr. Breen, an emergency doctor who provided frontline pandemic care in New York in early 2020. It was originally authorized from 2022 through 2024. The reauthorization would ensure seamless continuation of the grant programs, from 2025 through 2029.
On January 29, 2024, EDMA and ACEP urge the Tri-Departments to enforce the eventual finalized policies of the federal IDR operations proposed rule and to ensure effective dates are practical, reasonable and fair. Read our letter.
EDPMA Supports The Prudent Layperson Standard With House Bill 2093 in Arizona
On January 29, 2024 and February 26, 2024, EDPMA offered its strong support of House Bill 2093 in Arizona to reenforce the prudent layperson standard and expand the definition of emergency services. Read our House letter here. and letter to the Senate.
EDPMA Supports SB 584 In Florida
On January 24, 2024, supported Florida Senate Bill 584 to ensure health plans actively participate in the No Surprises Act Independent Dispute Resolution (IDR) program and require health ID cards to clearly indicate if they are part of a state-governed plan. Read our letter here. EDPMA also amplified Florida ACEP’s grassroots campaign to support this effort.
On January 2, 2024, EDPMA, ACEP and Illinois ACEP urge the Illinois Department of Healthcare and Family Services to include EM services in the proposed methods and standards $97.7M and $5M bonus rate increases for the Illinois Medicaid Practitioner Fee Schedule. Read the full letter here.
2023 Letters
EDPMA and ACEP Comment Letter On the Federal IDR Operations Proposed Rule
On December 21, 2023, EDPMA and ACEP commented on the Federal IDR Operations Proposed Rule including strong recommendations on improved communication through the IDR process, timing of the initial payment/denial of payment, open negotiation process, IDR initiation process, selection of an IDRE, batching provisions, federal IDR eligibility determinations, administrative fees, extenuating circumstances, a IDR registry, enforcement and effective dates. Read the full letter here.
EDPMA Supports The No Fees For EFTs Act
On December 14, 2023, EDPMA offered its support of the No Fees for EFTs Act to help restore one of the threats to medical practice viability by prohibiting health plans from imposing fees on EFTs to healthcare providers.
On December 12, 2023, EDPMA requested that the Departments prepare an extension to the 20-business day flexibility of an additional 40 business-days for initiating IDR for batched disputes to which the portal has been closed since August 3. Read the full letter here. The Departments heard our concerns for an EDPMA win!
EDPMA & HBMA Urge The CFPB To Ensure Accurate Medical Debt Reporting
On November 21, 2023, EDPMA and HBMA urged the Consumer Financial Protection Bureau (CFPB) to ensure accurate reporting of medical debt payment history. Read the full letter here.
EDPMA Coalition Letter Urging Congress to Reauthorize the PAHPA
On November 14, 2023, EDPMA and 100 other organizations urged Congressional leadership to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) to better position our country to prevent, prepare for and respond to national health security threats. Read the letter here.
EDPMA & ACEP Initial Response to Federal IDR Operations Proposed Rule
On November 10, 2023, EDPMA and ACEP thank the Departments for the proposed reforms included in the Federal IDR Operations Proposed Rule. We appreciate that the Departments incorporated much of our input from the last couple of years on how to improve the federal IDR process, so that the process is more efficient and effective—and the IDR process is more likely to be used as a last resort as the No Surprises Act intended. While we are generally supportive of many operational proposals in the proposed rule, we continue to assess all of the provisions and will submit a comprehensive comment letter by January 2. Read the letter here.
EDPMA CY24 MPFS Coalition Letter To Congress
On November 6, 2023, EDPMA joined 53 physician and healthcare organizations to urge Congress to stop the 3.4% cut in Medicare physician payment that the Centers for Medicare & Medicaid Services (CMS) recently finalized in the Calendar Year 2024 Medicare Physician Fee Schedule (PFS) final rule. Read the letter here.
EDPMA and ACEP Letter on the IDR Fee Proposed Rule
On October 26, 2023, EDPMA and ACEP commented on the Departments revised methodologies for setting the No Surprises Act federal IDR and IDRE administrative fees. Read the letter here.
EDPMA Letter to Ways and Means Regarding Rural Health RFI
October 5, 2023 – EDPMA responded to a House Ways & Means Committee RFI on “Improving Access to Health Care in Rural and Underserved Areas.” The letter can be found here.
EDPMA G2211 Coalition Letter to the Senate
On October 4, 2023, EDPMA signed on to a coalition letter to Senate leaders urging them to permanently halt the implementation of the G2211 add-on code that will cut Medicare payments to emergency physicians and other medical practices. The letter can be found here.
EDPMA G2211 Coalition Letter to the House
On October 4, 2023, EDPMA signed on to a coalition letter to leaders of the House urging them to permanently halt the implementation of the G2211 add-on code that will cut Medicare payments to emergency physicians and other medical practices. The letter can be found here.
EDPMA Statement For the Record, House Committee on Ways and Means
October 2, 2023 – EDPMA submitted this Statement For the Record for the September 19, 2023, House Committee On Ways and Means hearing entitled, “Reduced Care For Patients: Fallout From The Flawed Implementation of Surprise Medical Billing Protections.” This letter recommends improved regulations and enforcement so the No Surprises Act (NSA) will meet Congress’s goals of protecting patients, sustaining provider networks, and ensuring access to emergency care. We further state that a functional law will significantly benefit patients, employers, and clinicians, and reduce the need to access Independent Dispute Resolution (IDR).
EDPMA Comment Letter to the Texas Department of Insurance regarding ERISA opt-in to Texas Independent Dispute (IDR) Resolution Process proposed rule
On September 28, 2023, EDPMA urged TDI to consider including information related to which health plans are regulated by Texas and subject to the TDI IDR process.
EDPMA Recommendations To Fix The NSA
On September 15, 2023, EDPMA shared five concerns and solutions to the Tri-Department Secretaries to fix the No Surprises Act. The letter can be found here.
EDPMA Comment Letter on the CY 2024 OPPS Proposed Rule
On September 11, 2023, EDPMA shared a comment letter regarding the CY24 OPPS Proposed Rule with CMS. The comment letter can be found here.
EDPMA Comment Letter on the CY 2024 Physician Fee Schedule Proposed Rule
On September 11, 2023, EDPMA shared a comment letter regarding the CY24 Physician Fee Schedule Proposed with CMS. The comment letter can be found here.
EDPMA Concerned About IDR Portal Freeze after TMA II Ruling
On August 11, 2023, EDPMA strongly urges CMS to immediately issue updated instructions for the provider/payer IDR process and reopen the IDR process as quickly as possible. The letter can be found here.
CMS Response to EDPMA Letter Re: IDR Admin Fee
On July 11, 2023, The Department of Health and Human Services responded to EDPMA’s letter regarding the 2023 administrative fee increase. They noted that they are committed to establishing a fair, cost-effective, and reasonable IDR payment determination process that is accessible to disputing parties. The letter can be found here.
EDPMA-ACEP HELP Roundtable on NSA Follow-Up
In response to the Senate HELP Committee’s interest in the implementation issues of the No Surprises Act, EDPMA and ACEP summarized our recommendations to continue to keep patients out of the middle of billing disputes and to ensure the NSA is effective, fair and efficient. See our recommendations and letter here.
EDPMA Comment Letter on Medi-Cal Reimbursement
On Wednesday, June 14, 2023, EDPMA issued a letter on behalf of their California members urging the Assembly to include emergency medicine in the Medi-Cal reimbursement rates. The letter can be found here.
EDPMA Comment Letter on Advancing Interoperability and Improving Prior Authorization Proposed Rule
On Friday, March 10, 2023, EDPMA provided feedback on CMS’ Advancing Interoperability and Improving Prior Authorization proposed rule. The letter can be found here.
Washington State Coalition Letter on Delaying Switch to Federal IDR Process
On Wednesday, February 15, 2023, EDPMA joined coalition members in Washington State urging the state’s OIC to delay switching to the federal IDR process until at least July 1, 2024. The letter can be found here.
EDPMA-ACEP Comment Letter on the 2023 IDR Administrative Fees
On Monday, February 13, 2023, EDPMA and ACEP sent a letter to the Tri-Departments strongly opposing the 600% increase in IDR administrative fees and urged them to reinstate the originally announced $50 fee. The letter can be found here.
EDPMA Joins Coalition Urging CMS to Extend Telehealth Codes Through CY 2024
On Thursday, January 26, 2022, a coalition of over 45 organizations sent a letter to CMS urging the extension of telehealth codes through CY 2024 to align with Congress’ intent under the Consolidated Appropriations Act, 2023, which extends telehealth flexibilities through CY 2024. The letter can be found here.
EDPMA Joins Coalition Urging Medicare Payment Reform
On Monday, January 23, EDPMA joined a coalition of over 100 organizations urging Congress to reform the Medicare payment system. The letter can be found here.
EDPMA-ACEP Follow-up on NSA Implementation
On Thursday, January 19, 2023, EDPMA and ACEP sent a letter to the Tri-Agencies thanking them for the early January conversation and providing additional input and more detailed recommendations. The letter can be found here.
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