WASHINGTON, D.C.—Maintaining emergency services as a covered benefit and preserving the federal “prudent layperson” standard are top priorities for emergency physicians as Congress debates repeal and replacement of the Patient Protection and Affordable Care Act (ACA), according to Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP). Dr. Parker today urged Congress to enlist the help of the nation’s emergency physicians in the replacement process, following President Trump’s speech to the nation last night.

“Emergency physicians care for more than 140 million patients each year, and more than 500 emergency physicians will be in Washington, D.C., two weeks from now to meet with members of Congress and to advocate on behalf of our patients,” said Dr. Parker. “I and the 35,000 emergency physicians I represent want to work with Congress and the Trump Administration to cultivate a health care system that expands access for all patients, encourages innovation and ensures the continued availability of health care providers and services.”

Dr. Parker said the nation’s emergency departments focus on the traditional mission of providing urgent and life-saving care, although the role has expanded over past decades to encompass safety net care for uninsured and under-insured patients, as well as public health surveillance, disaster preparedness and filling gaps in care caused by physician shortages

ACEP issued the emergency medicine health care reform principles that it considers indispensable to any replacement legislation. The principles are aimed at maximizing access to medical care while improving its quality and lowering its costs.

• Maintain emergency services as a covered benefit for any insurance plan.
• Ensure the federal Prudent Layperson Standard extends to Medicaid fee-for-service and that compliance measures are in place for all other health plans. The prudent layperson standard requires health insurance companies to cover claims based on a patient’s symptoms, not the final diagnosis. It means, for example, if a patient has chest pain, but the diagnosis is a less urgent medical condition, such as a panic attack, the health insurance company must cover the emergency visit.
• Require health insurance transparency of data used to determine in- and out-of-network reimbursement rates for their patients' medical care. Ensure appropriate reimbursement rates for emergency services.
• Eliminate need for prior authorization for emergency services and guarantee parity in coverage and patient co-payments for in- and out-of-network emergency care services.
• Retain protections for pre-existing conditions, no lifetime limits and allowing children to remain on their parents' insurance plan until age 26.
• Enact meaningful medical liability reforms, including protections for physicians who provide federally-mandated EMTALA-related services, care for patients in a federally declared disaster area and who follow clinical guidelines established by national medical specialty societies.
• Ensure any continuation or expansion of Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Association Health Plans (AHPs) and Individual Health Pools (IHPs) provide meaningful health insurance benefits and coverage for individuals and families, including access to emergency care services.
• Repeal the Independent Payment Advisory Board (IPAB) and the excise tax on high-cost employer health benefit plans. Delay repeal of the Center for Medicare and Medicaid Innovation (CMMI) until at least 2020 or amend to eliminate mandatory provider participation in Medicare models. This will allow an adequate transition period for the Transforming Clinical Practice Initiative (TCPI) grants aimed at lowering costs, improving health outcomes and delivering more effective care.
• Acknowledge the role of freestanding emergency centers and other health care delivery models as crucial to encouraging coverage innovation.
• Protect the most vulnerable populations in this country by making sure Medicare, Medicaid and CHIP remain available and solvent for current and future generations.