Capital (30) Minutes Legislative News: • Three ACEP-supported Bills Introduced This Week • House Set to Vote on COVID-19 Relief Reconciliation Bill • Senate Hearings this Week for Biden Health Care Nominees Political Advocacy News: • Last Call: 911 Network Member Survey Closing Next Week! Regulatory News • Regs & Eggs: Paving the Way toward Value-Based Care: ACEP Submits an MIPS Value Pathway (MVP) Proposal to CMS • CMS Announces Automatic Hardship Exemption for MIPS for the 2020 Performance Period Due to COVID-19

Capital (30) Minutes Click here to watch this week’s Capital (30) Minutes where ACEP's Associate Executive Director of Public Affairs, Laura Wooster provides an update on the re-introduction of the emergency department violence bill and the status of COVID relief efforts.

Capital (30) Minutes airs live every other Wednesday at 2:00 PM ET. Click here to learn more.

Three ACEP-supported Bills Introduced this Week

1) The Workplace Violence Prevention Act for Health Care and Social Service Workers (H.R. 1195). This bipartisan legislation directs the Occupational Safety and Health Administration (OSHA) to issue standards for employers to implement on workplace violence prevention plans to protect health care and social service workers from assaults. ACEP previously supported this legislation that successfully passed the House during the 116th Congress (H.R. 1309).

Original sponsors of the legislation are Reps. Joe Courtney (D-CT), Robert C. “Bobby” Scott (D-VA), Chairman of the House Education and Labor Committee, (R-NE), (D-NC), Chairwoman of the House Education and Labor Subcommittee on Workforce Protections, (R-AK), (D-CA), Brian Fitzpatrick (R-PA), and (R-OK). Introduction of a companion bill in the Senate is expected in the next few weeks.

ACEP has highlighted the growing issue of violence against emergency physicians and health care workers for several years, and these incidents have unfortunately only increased over the course of the COVID-19 pandemic. ACEP and the Emergency Nurses Association issued a joint press statement in support of the bill, which you can read here.

2) The Mainstreaming Addiction Treatment Act (H.R. 1384, S. 445). This bipartisan bill, introduced by Reps. Paul Tonko (D-NY) and Sens. Maggie Hassan (D-NH) and Lisa Murkowski (R-AK), would eliminate the “X-waiver” requirement for physicians to prescribe buprenorphine, expanding the ability to use medication-assisted treatment (MAT) to help patients with opioid use disorder. ACEP has supported this legislation during previous sessions of Congress.

As you may recall from previous updates, during the last few days of the Trump Administration, the Department of Health and Human Services (HHS) issued guidelines to eliminate the X-waiver through the regulatory process. However, President Biden halted a number of regulations and executive orders issued during the lame duck period, including the X-waiver guidance. President Biden and his likely HHS Secretary Xavier Becerra have indicated they support removing the waiver but prefer to do so through the legislative process.

3) The National Coronavirus Commission Act of 2021 (H.R. 1306, S. 412). Introduced by Sens. Bob Menendez (D-NJ) and Susan Collins (R-ME) and Reps. (D-NJ) and Mario Diaz- Balart (R-FL), this bipartisan bill would establish an independent, non-partisan commission to assess the nation’s COVID-19 pandemic preparedness and response. The commission is modeled closely after the 9/11 Commission that investigated the September 11 terrorist attacks and would similarly be tasked with submitting its findings and recommendations to the President and Congress.

Among the tasks of the commission are examining the origins and spread of COVID-19; domestic and international public health surveillance; inter- and intra-governmental coordination; availability of PPE, vaccines, medical equipment, and other supplies; federal guidance and assistance for state, tribal, and local governments; research; economic relief policies; health and economic disparities; and preparedness and response of hospitals, nursing homes, and other congregate settings.

ACEP continues to work closely with the sponsors of each of these bills to help ensure their enactment into law and will provide continued updates as they move through the legislative process.

Please stay tuned for calls to action on The Workplace Violence Prevention Act for Health Care and Social Service Workers (H.R. 1195) and The Mainstreaming Addiction Treatment Act (H.R. 1384, S. 445) as we are working with the bill sponsors to garner additional co-sponsors for both bills. We will provide talking points and an email that you can personalize and easily send to your legislators.

House Set to Vote on COVID-19 Relief Reconciliation Bill The House of Representatives is set to vote Friday night on passage of the $1.9 trillion COVID-19 relief package, an expected party-line vote that will tee up the legislation for consideration in the Senate next week and passage into law by mid-March.

The broad bill includes a wide variety of provisions, including increased funding for vaccine production and distribution, aid to states and local governments, COVID-19 testing, as well as an ACEP priority based on the “Dr. Lorna Breen Health Care Provider Protection Act.” This provision delivers a total of $140 million in grant and education campaign funding - $80 million for mental and behavioral health training for health care professionals, other health care providers, and first responders, $20 million for an education and awareness campaign encouraging healthy work conditions and use of mental and behavioral health services by health care professionals, and $40 million for health care providers to promote mental and behavioral health.

Other provisions include $1,400 per person stimulus payments to American families, extended unemployment benefits, and nutritional assistance and other benefits. Democrats who pushed for including an increase in the federal minimum wage to $15 were dealt a blow on Thursday night, as the Senate parliamentarian ruled that it would violate the budget reconciliation procedures that are being used to pass the legislation on a simple majority vote. Whether or not there will be a continued fight to include the minimum wage hike remains to be seen, but regardless, the Senate will likely endure another long “vote-a-rama” when it considers the final bill on the floor.

ACEP is closely monitoring the proceedings on the relief bill to ensure that our emergency medicine priorities are signed into law as part of this relief package.

Senate Hearings this Week for Biden Health Care Nominees This week, the Senate continued the ongoing confirmation process for President Biden’s Cabinet and administrative nominations, including confirmation hearings for Health and Human Services (HHS) Secretary nominee Xavier Becerra, HHS Assistant Secretary nominee Rachel Levine, MD, and Surgeon General nominee Vivek Murthy, MD. Dr. Murthy previously served as Surgeon General in the Obama Administration and would return to the post with a focus on the continued response to the COVID-19 pandemic. Dr. Levine, former Secretary of the Pennsylvania of Department of Health, would mark the first transgender federal nominee to be confirmed by the Senate.

The Senate Health, Education, Labor, and Pensions (HELP) Committee and Senate Finance Committee both held confirmation hearings for HHS Secretary nominee Xavier Becerra. Becerra currently serves as the California Attorney General and served more than two decades in the House of Representatives, including as a member of the House Ways and Means Committee that has jurisdiction over the Medicare program. The hearings featured questions on the expected issues of insurance coverage, prescription drugs, the COVID-19 pandemic, and abortion, among many others.

Among Becerra’s responses that are of particular interest to ACEP included discussions about mental health, including provider mental health; a commitment to Sen. Chuck Grassley to help support implementation of an ACEP-supported law that passed as part of the 2020 year-end package to allow critical access and rural hospitals to convert into Rural Emergency Hospitals; a discussion with Sen. Maria Cantwell about the supply chain issues affecting drug shortages and PPE shortages and standards; several discussions in support of telehealth, with Becerra noting that with recent telehealth expansions are here to stay; and a commitment to Sen. Menendez about implementing the 1000 new graduate medical education slots provided in the year-end deal.

The confirmation of these nominees (and other nominees) is somewhat behind schedule, due to the events at the Capitol on January 6 and the subsequent second impeachment of former President Trump, as well as the budget reconciliation process to get President Biden’s COVID-19 relief plan across the finish line as soon as possible. ACEP staff continue to monitor the confirmation process to help advance our legislative and regulatory priorities as the new Administration gets fully underway.

Last Call: 911 Network Member Survey Closing Next Week! We would appreciate your feedback on how we can best support your advocacy efforts as a 911 Network member in 2021. Please take a few minutes to complete a short survey by March 5.

Click here to complete the survey.

Regs & Eggs: Paving the Way toward Value-Based Care: ACEP Submits an MIPS Value Pathway (MVP) Proposal to CMS This week, ACEP submitted a proposal to the Centers for Medicare & Medicaid Services (CMS) for an emergency medicine-focused Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). This submission represents another step in ACEP’s long-term effort to help transition emergency physicians to value-based care models, building off our work on the first, and only, proposed emergency medicine alternative payment model (APM), the Acute Unscheduled Care Model (AUCM).

Read the Regs & Eggs blog to find out more about what an “MVP” is, what ACEP’s proposed MVP looks like, and how the implementation of an emergency medicine-focused MVP may help pave the way towards more value-based care.

CMS Announces Automatic Hardship Exemption for MIPS for the 2020 Performance Period Due to COVID-19 There was another important MIPS-related announcement this week. On Thursday, CMS granted some needed relief to MIPS reporting requirements due to the COVID-19 pandemic. Specifically, CMS announced that clinicians eligible to participate in MIPS (most emergency physicians) will receive an automatic exemption from all four MIPS performance categories (MIPS Quality, Cost, Improvement Activities, and Promoting Interoperability performance categories) if they do not report any data from the 2020 performance period. In other words, if you have not yet reported data and choose not to do so, you will be held harmless and will not receive a bonus or penalty in 2022 based on your performance in MIPS in 2020. This represents a CHANGE IN POLICY. Previously, you were required to fill out an application to receive an exemption, and there was no automatic exemption. Under some circumstances, groups will still need to fill out an application, and therefore, CMS has reopened the application with a new deadline of March 31st at 8 pm EST.

Groups and individual clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus or potentially be subject to a penalty.

To learn more, please click here.

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