The AAEM Action Report

During the AAEM Emergency Medicine Advocacy Summit (EMAS), AAEM members convened over 80 meetings with their Members of Congress or their staff. From these meetings, we have identified a number of promising offices which have shown an interest in learning more or cosponsoring the Physician and Patient Safety Act. I Street is in the process of following up with these offices, however, in the coming days and weeks, I Street may reach out to you to ask that you follow up with the office separately to reinforce the cosponsor request. This additional outreach from you would be particularly helpful, as it demonstrates constituent support and can help move the conversation forward within the office.

During the recent EMAS fly-in, AAEM members also held productive meetings with key congressional offices regarding Corporate Practice of Medicine (CPOM), generating strong momentum for the CPOM bill led by Senator Warren (which has not yet been introduced). Senate and House interest is growing, and AAEM members had several promising discussions on the bill as we search for a co-lead to introduce the bill.

On June 25th, AAEM President Dr. Vicki Norton will participate in a Breakup Big Medicine conference organized by the American Economic Liberties Project and The Century Foundation. Norton will join policymakers, physicians, and labor to examine the role of corporate power in healthcare and to announce the new Break Up Big Medicine Coalition.

On June 9th, the House Appropriations Committee marked up, along party lines, the fiscal year (FY) 2027 Labor, Health and Human Services, Education, and Related Agencies bill.

The report accompanying the bill refers to two different hospital diversion pilot programs intended to address the emergency room (ER) boarding crisis, especially for individuals in a mental health crisis. The report “encourages the HHS Department to implement a pilot program modeled after successful State hospital diversion programs, in which young people experiencing a mental health crisis and at risk of being hospitalized are instead referred to receive care at home from trusted behavioral and mental health providers.”

The bill provides a total discretionary allocation of $110.8 billion for the Department of Health and Human Services (HHS), representing roughly $4 billion, or 4%, below the FY 2026 enacted level. The bill contains a small funding increase for the National Institutes of Health (NIH). On party lines, Republicans voted to reject a Democratic amendment that would have blocked implementation of the recent Office of Management and Budget (OMB) rule regarding grantmaking. The Committee did come together on a bipartisan basis to oppose the Administration’s efforts around multiyear funding. The language instructs NIH not to extend its multiyear funding model to a greater amount of funding in fiscal 2027 than the model was used for in prior fiscal years.

On May 21st, Rep. Aaron Bean (R-FL) hosted a summit on the independent dispute resolution (IDR) issue where employers, hospitals, and insurer representatives said that significant arbitration awards encourage some providers to remain out of network and drive-up health care costs. On May 26th, Bean followed up with a press release highlighting the summit entitled, Six Key Moments: Path to Consensus Series, Surprise Billing and Utilization Challenges.

On June 17th, Senators Tammy Baldwin (D-WI), Ron Wyden (D-OR), and Minority Leader Chuck Schumer (D-NY) and Reps. Kathy Castor (D-FL) and Tom Suozzi (D-NY) introduced a Congressional Review Act (CRA) resolution to repeal the Affordable Care Act (ACA) marketplace rule which limits ACA consumer subsidies. CRA resolutions are an unlikely avenue for overturning final regulations.

The On May 29th, the OMB proposed a comprehensive proposed rule on federal grantmaking. The rule has multiple sections:

• Political appointees. Requires senior political appointees to review and sign off on all discretionary grant proposals, giving them the final say over funding.
• Restrictions on federal funds. Federal funds cannot be used to promote subjects such as diversity equity and inclusion (DEI).
• Termination Clauses. Agencies are granted the authority to alter terms or unilaterally cancel discretionary awards mid-cycle if they no longer align with the President’s priorities.
• Ban on International Collaborations. The rules enforce prohibitions on research collaborations with “covered foreign entities”.
• Shift in Award Models. The proposed rule includes cost-reimbursement models rather than fixed costs and expands the criteria of unallowable costs.

AAEM joined over 300 other organizations in signing a stakeholder letter asking for an extension of the comment period. The Administration has decided against extending the comment period.

The Federal Trade Commission (FTC’s) proposed consent order — approved by the Commission in a 2-0 vote, requires Ascension to divest seven AMSURG ambulatory surgery centers (ASC) for the Ascension acquisition to move forward. Shortly after receiving FTC approval, Ascension closed its deal which established the nonprofit health system as the country’s third-largest ASC platform, with more than 300 such locations.

On May 28th, the administration finalized its long outstanding IDR rule attempting to strengthen and improve the No Surprises Act’s IDR process. The administration reduced the non-refundable administrative fee that both parties in a dispute must pay by 85% — from $115 to $15 per party, which CMS believes will lower barriers to participation.

The IDR operations rule, initially issued under the Biden administration in 2023, sought to address issues with the IDR process based on feedback from users. The final rule issued by the administration mostly maintains these goals. The final rule requires insurers to use standardized claim codes when communicating about out-of-network services, which should help providers determine if a claim qualifies for the IDR and reduce confusion and ineligible disputes. The final rule also provides more flexibility for certain claims to be resolved together in a “batched” dispute.

“Users will be able to start disputes, track status, and manage activity in one place. Eventually, the IDR Gateway will be used to require payers to register, making it easier for providers to identify the correct party, reduce errors, and avoid unnecessary disputes. Other additional features, including in-portal negotiation, will roll out over time to improve accountability and reduce unnecessary filings,” according to the CMS press statement.

On June 15th, the Congressional Budget Office (CBO) published a blog regarding The No Surprises Act’s (NSA) IDR process and said that it may not be producing the cost savings that were originally projected, leading to higher health care prices and insurance premiums.

CBO said, “Emerging evidence suggests that the law might not have the effects that CBO anticipated. Although prices for some services that had high rates of surprise billing before the law’s enactment have declined (after adjusting them for inflation), several published reports indicate that providers are winning more than 8 in 10 IDR cases and are being awarded payments that are much higher than expected, particularly in certain geographic areas. CBO is therefore seeking research that evaluates the law’s effects on health care prices and network participation.”

• Connecticut SB 196, an anti-CPOM bill, was signed into law and became effective on May 29th.
• New Jersey S 2996 which expanded the scope of practice for APRNs became effective on March 30th.

SB 313 protects Delaware’s nonprofit acute care hospitals from acquisition by entities other than charities or not-for-profit entities. The bill passed the Senate on June 11th and was reported favorably out of committee on June 18th.