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Topics in Emergency Medicine
Weekly Update

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October 13, 2000

WEEKLY UPDATE for October 13, 2000

1) FY 20001 Appropriation Bills
2) Balanced Budget Act "Giveback" Bill (H.R. 5291 & S. 3165)
3) Patients' Bill of Rights
1) HCFA Delays Implementation of OPPS EMTALA Provisions
2) HCFA Physician Encounter Data Requirements Begin This Month
See ACEP's Conference "Preserving America's Health Care Safety Net"
Great Events at Scientific Assembly! We want to see you in Philadelphia!


Despite optimistic plans early in the week to end this congressional session on Saturday, Republican leaders acknowledged that they would need at least another week complete funding bills. The House and Senate are expected to pass a third continuing resolution that will keep the federal government operating at fiscal 2000 levels through October 20.

1) FY 20001 Appropriation Bills

At the end of the second week of fiscal 2001 only 3 of the 13 spending bills are signed into law. At least 3 additional measures are cleared for vote next week and 3 more are still in negotiations. House Republican leaders indicated their intention to reserve the Labor/HHS/Education bill as the foundation for an end-of-year "catch all" package; the Senate disagreed. Appropriators said that the Labor/HHS/Education package would be filed as early as October 17, making it eligible for a vote thereafter.

2) Balanced Budget Act "Giveback" Bill (H.R. 5291 & S. 3165)

In a letter to House Speaker Dennis Hastert (R-IL), President Clinton criticized Republicans for giving between 40%-55% of the Medicare "giveback" monies to HMOs, while simultaneously being unwilling to support patients' rights legislation that would hold insurers accountable. Current estimates show that HMOs will get at least $8 billion in direct payments and an additional several billion in indirect payments. The overall measure is estimated to cost $28 billion over 5 years primarily due to payments to HMOs, hospitals, home health agencies, and skilled nursing homes.

3) Patients' Bill of Rights

Partisan tensions continue to cause gridlock on the final version of the Republican patients' bill of rights. Rep. Charlie Norwood (R-GA) and Sen. John McCain (R-AZ) introduced a new version of the bill that limits punitive damages in federal court at $5 million and toughens provisions for the types of injuries a patient must have in order to file a lawsuit. Previous Democratic proponents of the original Norwood-Dingell bill, Sen. Ted Kennedy (D-MA) and Rep. John Dingell (D-MI), did not endorse the new McCain version. The new bill however did gain the endorsement of Sen. John Ashcroft (R-MO) who is locked in a tight reelection battle. His support increases to 51 the number of supporters in the Senate who favor the Norwood-Dingell measure.

House leaders met throughout the week with medical specialty societies, including ACEP, to establish a workable compromise that Speaker Hastert will bring to Sen. Trent Lott (R-MS) for Senate consideration. Reps. Norwood and Dingell have been included in this process. With time running out, a clear Senate strategy has yet to emerge.


1) HCFA Delays Implementation of OPPS EMTALA Provisions

On October 3, the Health Care Financing Administration published a notice in the Federal Register, delaying the effective date of several provisions of the Medicare hospital outpatient prospective payment system. The provisions, which were scheduled to be effective on October 10, 2000, will be effective on January 10, 2001. The delayed provisions include the modifications made to the EMTALA regulations, including the revised definitions; and the requirements for determining provider-based status.

HCFA stated that it decided to delay implementation of these provisions due to the need for additional guidance from the agency and the dissemination of additional training material. HCFA also plans to host a town hall meeting in the near future to discuss specific aspects of the provider-based regulations.

2) HCFA Physician Encounter Data Requirements Begin This Month

The Balanced Budget Act of 1997 required the Health Care Financing Administration to implement a risk adjustment payment methodology for payment to Medicare+Choice organizations that accounts for variations in payment based on health status of the organizations' enrollees. The new methodology is intended to pay plans more accurately, according to the health of their enrollees. Beginning October 1, Medicare+Choice organizations must submit physician encounter data to HCFA for services provided on or after October 1. The encounter data includes both diagnostic and procedure codes. In order for Medicare+Choice organizations to submit the required information to HCFA, physicians treating Medicare+Choice enrollees must submit the data to the plans. HCFA is advising physicians to consult with health plans to determine the appropriate reporting forms.


The Kaiser Family Foundation filmed ACEP's September 19 conference, "Preserving America's Health Care Safety Net" at the National Press Club in Washington, DC. Below are the website addresses for each of the conference presentations.

NOTE: You must have Real Audio installed on your computer to view this material.

  1. Welcome & Keynote Address
  2. Health Care System Infrastructure and the Emergency Department as pat of the Health Care Safety Net
  3. Defining the Safety Net
  4. Luncheon - The RIteCare Experience
  5. Delivering High Quality, Cost-Effective Care/ Economics of Emergency Medicine
  6. Access and Barriers to the Nation's Safety Net: A Review/Analysis of Current Policy Proposals
  7. Where Do We Go From Here? & Concluding Remarks


We look forward to seeing you all at ACEP's Scientific Assembly in Philadelphia, PA! Below is the list of political, legislative, and regulatory events. Please stop by with questions or just to say hello to your public affairs staff!

  1. NEMPAC 20th Anniversary Celebration!
    Sunday, October 23, 2000 6:00 pm to 7:30 pm in Room 407-409 Philadelphia Marriott
  2. NEMPAC Invitational Dinner
    Sunday, October 23, 2000 7:30 pm to 9:30 pm in Room 414-415 Philadelphia Marriott
  3. School of Political Advocacy-- Featuring Michael Dunn
    Monday, October 23, 2000 1:00 pm to 4:00 pm in Salon 1 at the Philadelphia Marriott
  4. Luncheon for New & Former Graduates of the School of Political Advocacy Featuring Tucker Carlson
    Tuesday, October 24, 2000 11:15 am to 12:30 pm in Salon D at the Philadelphia Marriott
  5. Legislative and Regulatory Issues Briefing
    Wednesday, October 25, 2000 9:00 am to 11:00 am in Room 202 A&B at the Convention Center
  6. The Public Affairs Booth
    Monday October 23 through Wednesday October 25 9:30 am to 3:30 pm at the ACEP Resource Center in the Philadelphia Convention Center
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