Staying informed about federal policy changes is crucial for emergency departments and freestanding ERs navigating complex reimbursement and operational challenges. The latest “Health on the Hill” briefing from April 9, 2025, highlights several developments that could directly impact ED physician groups and their business partners. Below is a summary of key updates, with insights from QMACS on how these changes may affect your operations and revenue cycle.
Legislation and Policy Activity to Watch
House Budget Negotiations in Motion
The House is considering a Senate amendment to the FY2025 budget resolution (H. Con. Res. 14), which could introduce changes to Medicare, Medicaid, GME funding, and emergency care reimbursement. Providers should prepare for potential shifts in payment models, particularly for facilities serving high volumes of Medicare and Medicaid patients.
Congressional Hearing on FDA Oversight
The House Oversight Committee recently held a hearing titled “Restoring Trust in FDA: Rooting Out Illicit Products.” This signals potential regulatory tightening on emergency-use or off-label therapeutics, which could impact the availability and oversight of commonly used ED medications.
Final Rule on Medicare Advantage and Part D
CMS has finalized a rule affecting Medicare Advantage, Part D, and Dual Eligible Special Needs Plans (D-SNPs). The changes include new drug pricing reforms and payment model adjustments, which may influence ED reimbursement rates and drug utilization patterns. The rule takes effect June 3, 2025.
Behavioral Health and Workforce Policy
PEER Support Act Reintroduced
Legislation (S.1329/H.R.2741) aims to strengthen the behavioral health workforce by funding peer support specialists. For EDs experiencing high volumes of behavioral health cases, this bill could provide opportunities for care collaboration and new funding streams, potentially easing ED boarding pressures.
Biomedical and Innovation Developments
Upcoming Senate Hearing on Research Funding
An April 30 Senate hearing titled “Biomedical Research: Keeping America’s Edge in Innovation” will examine federal support for diagnostics and therapeutics. Innovation in these areas often trickles down to ED care, especially in trauma, stroke, and critical care.
New Legislation: BRAIN Act (S.1330)
While focused on brain tumor research, this bill reflects growing federal interest in neurological care—an area relevant to EDs handling stroke and head trauma cases.
FDA Regulatory and Access Updates
Legacy Drug Access Preserved
Several generics frequently used in EDs—such as DECADRON, NASCOBAL, and VIBRAMYCIN—were confirmed by the FDA as not withdrawn for safety reasons. Continued access supports cost-effective, reliable treatment options in urgent care settings.
Dataset-JSON Pilot Proposal
The FDA is seeking feedback on a proposal to modernize clinical trial data standards. If implemented, this could accelerate the approval of emergency-use drugs and streamline the authorization process for new treatments.
Important Dates to Monitor
- Public comment deadline for Dataset-JSON proposal: June 9
- NIH Advisory Council meetings on alcohol abuse (May 13) and heart, lung, and blood health (June 11) may preview future research funding priorities.
Implications for Emergency Medicine Providers and RCM Leaders
- Monitor Medicare Advantage and Medicaid policy shifts for potential revenue cycle impacts.
- Evaluate how FDA reforms and drug access decisions may affect formularies and treatment options.
- Support behavioral health legislation as a path to reducing ED overcrowding and improving care coordination.
- Stay engaged with congressional budget discussions—changes to GME, emergency preparedness, or physician reimbursement could be on the horizon.
How QMACS Can Help
From payer policy updates to IDR support and coding guidance, QMACS provides end-to-end revenue cycle management tailored to emergency medicine. As policy continues to evolve, we help ensure your operations remain compliant, efficient, and financially secure.
Have questions about how these changes could affect your group? Contact QMACS today for a consultation.