Wednesday, December 30, 2009

Emergency Medicine in the Health Reform Bills

Work continues in D.C. to produce a health reform package to send the president. Here is a short summary of the provisions that directly concern emergency medicine:

Both the House bill (HR 3962) and the Senate bill (HR3590) contain the following elements:

*Include emergency services as part of an essential health care benefits package.
*Contain emergency care/trauma regionalization pilot project grants.
*Contain trauma stabilization grants.
*Include the HHS demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.

The House bill contains these elements:

*Quality improvement measures for ED patient through put.
*Statutory authorization for ECCC & ECCC Council of Emergency Medicine.
*HHS annual report to Congress on ECCC activities with focus on ED crowding/boarding and delays in ED care.
*Establishes HHS incentive payments to states that establish medical liability reforms such as Certificate of Merit or early offer.

The Senate bill contains these elements:

*Directs Secretary of HHS to expand emergency medicine research and pediatric emergency medicine research at NIH, AHRQ, HRSA, CDC, et. al.
*Reauthorizes EMSC for five years
*Requires Exchange health plans to provide emergency services without regard to prior authorization or the contractual relationship to the Emergency Physician or the Emergency Physician Group
*Applies the Patient's Bill of Rights and the prudent layperson standard to all health care plans

In addition there was a provision for an HHS working group to develop ED boarding and ambulance diversion standards and to develop quality measures for hospitals to improve ED efficiency and patient flow. This will be addressed administratively, so it is no longer necessary to provide this in the legislative language.

ACEP fought hard for a time extension for Section 1011 (Federal reimbursement of emergency health services provided to individuals not lawfully present in the U.S.) It was not included in the Senate Manager's amendment. It may still be considered as the House-Senate Conference negotiations continue.

As the negotiations continue through the holidays and into the New Year, I'll keep you posted on the latest changes.


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