Archive for News

EDPMA Supports TMA’s Lawsuit and the Implementation of the No Surprises Act as Intended

McLean, Virginia – The Emergency Department Practice Management Association (EDPMA) fully supports the Texas Medical Association’s efforts to hold accountable the Department of Health and Human Services, Department of Labor and the Department of Treasury (the Departments) to ensure fair and equitable implementation of the No Surprises Act as intended. To read the full press release click here.

EDPMA Applauds the Ways and Means Committee Leadership for Urging Swift Action to Fix the Flawed Implementation of the No Surprises Act

In a strongly worded letter, Representatives Richard Neal and Kevin Brady, the Chairman and Ranking Member of the House Ways and Means Committee, urged three cabinet secretaries to take “swift action” to fix the No Surprises Act (NSA) final rule. Read the letter here.

The letter reminded the Secretaries that the No Surprises Act intentionally detailed a dispute resolution process that required arbitrators to equally consider several factors for their decision-making process, not just the Qualifying Payment Amount as some of our members are seeing in practice.

The final rule introduced a new “double counting” test that has no basis in the statutory text, directing IDR entities to “consider whether the additional information is already accounted for in the QPA… Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA.”

They further called out the Departments about their slow rollout of the Advanced Explanation of Benefits provision in the NSA.

EDPMA applauds the Ways and Means Committee leadership and stands with Representatives Neal and Brady in their demand to ensure the No Surprises Act aligns with the law and to “make the law’s transparency provisions a reality for patients.”

EDPMA Files Amicus Brief in TMA et al v. HHS et al

On Wednesday, October 19, 2022, EDPMA filed an amicus brief in support of the plaintiffs in Texas Medical Association, Dr. Adam Corley, and Tyler Regional Hospital, LLC, v. United States Department of Health and Human Services, Department of Labor, Department of the Treasury, Office of Personnel Management, and the current heads of those agencies in their official capacities.

The press release can be found here and the amicus brief with exhibits can be found here.

EDPMA Submits Response to MACRA RFI

On Wednesday, October 19, 2022, EDPMA submitted a response to the request for Information on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In the letter, EDPMA calls on Congress to begin the process of reform as soon as possible by convening roundtables with affected stakeholders and/or hearings in the Committees of jurisdiction to inform potential legislative solutions, highlighting reimbursement instability and MIPS and APMs as areas to address.

The letter can be found here.

EDPMA Letter in Support of HR 8800

On Monday, September 26, 2022 EDPMA sent a letter to Reps. Bera and Bucshon thanking them for introducing HR 8800, Supporting Medicare Providers Act of 2022, and in support of the bill. The letter can be found here.

EDPMA Submits Comments on REH Proposed Rule

On Tuesday, September 13, 2022, EDPMA submitted comments to CMS on 2023 Hospital Outpatient Prospective Payment System (OPPS) and Rural Emergency Hospitals (REH) proposed rule. The letter focused on REH provisions. The letter can be found here.

EDPMA Letter to Congressional Committee Leaders on MPFS Cuts

On Monday, September 12, EDPMA sent a letter to congressional committee leaders requesting that Congress act before the end of the year to mitigate expected Medicare Physician Fee Schedule (MPFS) cuts in calendar year 2023. EDPMA is asking Congress to address the short-term issue of stabilizing Medicare reimbursement in 2023 by increasing the Medicare CF in 2023 by at least 4.5 percent, waiving the 4 percent PAYGO cut, and providing an inflationary update based on the Medicare Economic Index (MEI). EDPMA is also urging Congress to work towards a long-term solution to provide an annual inflationary update to provide greater stability for physicians participating in the Medicare program and their patients. The letter can be found here.

EDPMA Submits 2023 MPFS Comment Letter

On Tuesday, September 6, EDPMA submitted a comment letter on the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. The letter can be found here.

EDPMA Comments on Conditions of Participation for REH and Critical Access Hospitals

On Thursday, August 25, 2022, EDPMA filed a comment letter with CMS on the Conditions of Participation for Rural Emergency Hospitals (REH) and Critical Access Hospital conditions of participation updates. The letter can be found here.

Tri-Agencies Release Final Rule

On Friday, August 19, 2022, The U.S. Departments of Labor, Health and Human Services, and the Treasury this afternoon released a final rule further implementing provision of the No Surprises Act.

This rule addresses the IDR components of the legislation and responds to the federal court ruling from earlier this year regarding the approach that arbiters must take when making a payment determination in federal IDR.

NOTE: this is separate from the proposed rule which has cleared OMB and we are expecting soon, which will focus on the Advanced EOB provisions of the NSA as well as “Other Provisions.”

Additional resources:

Stay tuned for additional information and analysis.