Bush Abandons Rule On Limiting ER Use (Two articles)

Thu, 23 Jan 2003 10:21:36 -0800

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-----Original Message-----
From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 
Sent: Thursday, January 23, 2003 10:02 AM

Bush Administration Reverses Decision on Limits on Medicaid Emergency
Service 

01/23/2003 

The Bush administration yesterday reversed a recent decision that would have
allowed states to limit some emergency services for Medicaid beneficiaries,
the Wall Street Journal reports (Lueck, Wall Street Journal, 1/23). In a
letter last month to state Medicaid directors, the Bush administration said
that managed care organizations can limit and restrict coverage of emergency
services for Medicaid beneficiaries. The decision would have removed
restrictions established in the 1997 Balanced Budget Act and in rules issued
by the Clinton administration in January 2001 and by the Bush administration
in June 2002. Under the 1997 law, states can require Medicaid beneficiaries
to enroll in HMOs or other MCOs. However, the law requires MCOs to provide
coverage for emergency services in cases that a "prudent layperson" would
consider an emergency. The law also allows Medicaid beneficiaries enrolled
in MCOs to have access to emergency services "immediately at the nearest
provider." The administration said the decision would have allowed states to
place certain limits on coverage of emergency services "to facilitate more
appropriate use of preventive care and primary care" (
<http://www.californiahealthline.org/members/basecontent.asp?contentid=47720
&collectionid=3&program=1&contentarea=21729%20> California Healthline,
1/17). Republican and Democratic Senate aides criticized the decision, which
they said could affect the ability of Medicaid beneficiaries to access
"rapid care" in an emergency. In addition, Sen. Bob Graham (D-Fla.) had
planned to ask the Senate to vote to overturn the decision (Goldstein,
<http://www.washingtonpost.com/wp-dyn/articles/A30202-2003Jan22.html>
Washington Post, 1/23). Senate aides said that lawmakers would have
overturned the decision (Pear,
<http://www.nytimes.com/2003/01/23/politics/23HEAL.html> New York Times,
1/23). In a letter to Senate Finance Committee Chair Charles Grassley
(R-Iowa), CMS Administrator Tom Scully said that the administration reversed
the decision to end the dispute over a "rather overblown issue." The
reversal "delighted" a number of lawmakers from both parties, as well as
health care advocacy groups, the Post reports (Washington Post, 1/23).

Bush Abandons Rule On Limiting ER Use 
Congress Fought Medicaid Regulation 

By Amy Goldstein
Washington Post Staff Writer
Thursday, January 23, 2003; Page A03 

The Bush administration yesterday abandoned a rule it had issued a month ago
that allowed states to limit the use of hospital emergency rooms by patients
on Medicaid, acquiescing to fierce opposition from members of Congress and
advocates for the poor.

In a letter sent late yesterday to leaders of the Senate Finance Committee,
the top federal administrator who oversees Medicaid wrote that "we are
rescinding" the rule, which essentially undercut a basic protection that
Congress had guaranteed every Medicaid patient in managed care.

The abrupt pivot came a day after Republican and Democratic Senate aides
protested restrictions on emergency room use at a meeting with
administration health officials -- and hours before a Democratic senator had
planned to seek a Senate vote to try to overturn it. The shift also comes
just a week before President Bush intends to ask Congress to make expensive
and controversial changes to other aspects of federal health policy, notably
Medicare, the other large public insurance program, which covers the
elderly.

The letter's author, Thomas A. Scully, administrator of the Centers for
Medicare and Medicaid Services, said the administration was eager to defuse
a dispute over what he called the "rather overblown issue" of emergency room
use by Medicaid patients, at a time when "we are trying to get a lot of
stuff done."

"We weren't troubled by the policy. We were troubled by the controversy it
caused," Scully said in an interview. "We want to get off to a friendly,
happy, bipartisan start of the year. This clearly wasn't doing it."

A White House official said the president's aides were aware of the agency's
latest decision and supported it.

The pivot delighted senators and House members of both political parties,
along with outside consumer health lobbyists, who had said the rule might
impede the ability of some of the nation's neediest patients to get rapid
care when they need it. "Hallelujah!" said Ron Pollack, executive director
of Families USA, a liberal health care lobby, who had said late last week
that opponents were preparing to contest the policy in federal court.

Sen. Bob Graham (D-Fla.), who sponsored the emergency room protection and
had been preparing to ask for the Senate vote last night, praised the
administration for changing its position. "Returning to the original
standard will not only protect coverage for Medicaid patients, it will save
lives," Graham said. Sen. Edward M. Kennedy (D-Mass.) was more pointed,
saying in a statement that "it is unconscionable that the administration
would have issued and defended this policy in the first place."

The reversal ends a brief, and unusual, episode in the history of Medicaid,
a program shared by the federal government and states that provides
insurance to 37 million poor or disabled people. The rule had the potential
to affect as many as 23 million Medicaid patients who are required by states
to belong to health maintenance organizations or other forms of managed
care.

Already, states are permitted to restrict payments for use of emergency
rooms by people under "fee for service" Medicaid, in which patients choose
whatever doctors they want. But under a 1997 law, intended to protect the
increasing proportion of Medicaid patients in managed care, states must pay
for emergency room services whenever a "prudent layperson" could reasonably
think they have a true medical emergency. The rule, issued in late December,
reinterpreted that law.

The change was odd because the nation's governors and Medicaid directors had
not requested it, even though they lobby often for other kinds of freedom to
run their Medicaid programs -- and many of them lately have been leaning
hard, and unsuccessfully, on the administration for financial help with
Medicaid deficits.

Gregory A. Vadner, vice chairman of the National Association of State
Medicaid Directors, said the reversal would have little practical effect
because states had not begun planning to restrict emergency room use based
on the administration's rule. "Really, in the big scheme of things, I don't
think it will be something that all the states will be greatly disappointed
about," said Vadner, Missouri's Medicaid director.

When members of Congress began to protest last week, administration
officials defended their decision by saying their new policy would create
equal rules for all Medicaid patients, regardless of whether they were in
managed care. The administration also said the rule was an attempt to curb
reliance on emergency rooms for routine care that is more efficient -- and
economical -- for them to get in doctors' offices.

In yesterday's letter to Senate Finance Committee Chairman Charles E.
Grassley (R-Iowa) and the ranking member, Sen. Max Baucus (D-Mont.), Scully
said the administration wanted to work with Congress to find other ways of
discouraging unnecessary use of emergency rooms.

(c) 2003 The Washington Post Company

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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b> California Healthline
[mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] <br>
<b><span style='font-weight:bold'>Sent:</span></b> </span></font>Thursday, January 23, 2003 10:02 AM<br>
<br>
</p>

<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>&nbsp;</span></font></p>

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  <td style='padding:1.5pt 1.5pt 1.5pt 1.5pt'>
  <p class=MsoNormal><b><font size=2 color=black face=Arial><span
  style='font-size:10.5pt;font-family:Arial;color:black;font-weight:bold'>Bush
  Administration Reverses Decision on Limits on Medicaid Emergency Service </span></font></b></p>
  </td>
 </tr>
 <tr>
  <td style='padding:1.5pt 1.5pt 1.5pt 1.5pt'>
  <p class=MsoNormal><i><font size=1 color=black face=Arial><span
   style='font-size:9.0pt;font-family:Arial;color:black;font-style:italic'>01/23/2003</span></font></i><font
  size=1 color=black face=Arial><span style='font-size:9.0pt;font-family:Arial;
  color:black'> </span></font></p>
  </td>
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<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
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<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
9.0pt;font-family:Arial;color:black;display:none'>&nbsp;</span></font></p>

<table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%"
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 <tr>
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  <div>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>The Bush administration
  yesterday reversed a recent decision that would have allowed states to limit
  some emergency services for Medicaid beneficiaries, the <cite><i><font
  face=Arial><span style='font-family:Arial'>Wall Street Journal</span></font></i></cite>
  reports (Lueck, <cite><i><font face=Arial><span style='font-family:Arial'>Wall
  Street Journal</span></font></i></cite>, 1/23). In a letter last month to
  state Medicaid directors, the Bush administration said that managed care
  organizations can limit and restrict coverage of emergency services for Medicaid
  beneficiaries. The decision would have removed restrictions established in
  the 1997 Balanced Budget Act and in rules issued by the </span></font><font
    size=1 color=black face=Arial><span style='font-size:9.0pt;font-family:
    Arial;color:black'>Clinton</span></font><font size=1 color=black
  face=Arial><span style='font-size:9.0pt;font-family:Arial;color:black'>
  administration in January 2001 and by the Bush administration in June 2002.
  Under the 1997 law, states can require Medicaid beneficiaries to enroll in
  HMOs or other MCOs. However, the law requires MCOs to provide coverage for
  emergency services in cases that a &quot;prudent layperson&quot; would
  consider an emergency. The law also allows Medicaid beneficiaries enrolled in
  MCOs to have access to emergency services &quot;immediately at the nearest
  provider.&quot; The administration said the decision would have allowed
  states to place certain limits on coverage of emergency services &quot;to
  facilitate more appropriate use of preventive care and primary care&quot; (<a
  href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47720&amp;collectionid=3&amp;program=1&amp;contentarea=21729%20"
  target=blank><cite><i><font face=Arial><span style='font-family:Arial'>California
  Healthline</span></font></i></cite></a>, 1/17). Republican and Democratic
  Senate aides criticized the decision, which they said could affect the
  ability of Medicaid beneficiaries to access &quot;rapid care&quot; in an
  emergency. In addition, Sen. Bob Graham (D-Fla.) had planned to ask the
  Senate to vote to overturn the decision (</span></font><font size=1
    color=black face=Arial><span style='font-size:9.0pt;font-family:Arial;
    color:black'>Goldstein</span></font><font size=1 color=black face=Arial><span
   style='font-size:9.0pt;font-family:Arial;color:black'>, <a
   href="http://www.washingtonpost.com/wp-dyn/articles/A30202-2003Jan22.html"
   target=blank><cite><i><font face=Arial><span style='font-family:Arial'>Washington</span></font></i></cite><cite><i><font
  face=Arial><span style='font-family:Arial'> Post</span></font></i></cite></a>,
  1/23). Senate aides said that lawmakers would have overturned the decision
  (Pear, <a href="http://www.nytimes.com/2003/01/23/politics/23HEAL.html"
  target=blank><cite><i><font face=Arial><span style='font-family:Arial'>New
  York Times</span></font></i></cite></a>, 1/23). In a letter to Senate Finance
  Committee Chair Charles Grassley (R-Iowa), CMS Administrator Tom Scully said
  that the administration reversed the decision to end the dispute over a
  &quot;rather overblown issue.&quot; The reversal &quot;delighted&quot; a
  number of lawmakers from both parties, as well as health care advocacy
  groups, the <cite><i><font face=Arial><span style='font-family:Arial'>Post</span></font></i></cite>
  reports (<cite><i><font face=Arial><span style='font-family:Arial'>Washington
  Post</span></font></i></cite>, 1/23). </span></font></p>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
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<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
9.0pt;font-family:Arial;color:black;display:none'>&nbsp;</span></font></p>

<p class=MsoNormal><b><font size=4 color=black face=Arial><span
style='font-size:13.5pt;font-family:Arial;color:black;font-weight:bold'>Bush
Abandons Rule On Limiting ER Use </span></font></b><font size=2 color=black
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:black'><br>
Congress Fought Medicaid Regulation </span></font></p>

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<p class=MsoNormal><i><font size=2 color=black face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:black;font-style:italic'>By Amy
Goldstein</span></font></i><font size=2 color=black face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:black'><br>
</span></font><font size=2 color=black face=Arial><span style='font-size:10.0pt;
  font-family:Arial;color:black'>Washington</span></font><font size=2
color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'> Post Staff Writer<br>
Thursday, </span></font><font size=2 color=black face=Arial><span
 style='font-size:10.0pt;font-family:Arial;color:black'>January 23, 2003</span></font><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'>; Page A03 </span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The Bush administration yesterday
abandoned a rule it had issued a month ago that allowed states to limit the use
of hospital emergency rooms by patients on Medicaid, acquiescing to fierce
opposition from members of Congress and advocates for the poor.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>In a letter sent late yesterday to
leaders of the Senate Finance Committee, the top federal administrator who
oversees Medicaid wrote that &quot;we are rescinding&quot; the rule, which
essentially undercut a basic protection that Congress had guaranteed every
Medicaid patient in managed care.</span></font></p>

The abrupt pivot came a day after
Republican and Democratic Senate aides protested restrictions on emergency room
use at a meeting with administration health officials -- and hours before a
Democratic senator had planned to seek a Senate vote to try to overturn it. The
shift also comes just a week before President Bush intends to ask Congress to
make expensive and controversial changes to other aspects of federal health
policy, notably Medicare, the other large public insurance program, which
covers the elderly.

The letter's author, Thomas A. Scully,
administrator of the Centers for Medicare and Medicaid Services, said the
administration was eager to defuse a dispute over what he called the
&quot;rather overblown issue&quot; of emergency room use by Medicaid patients,
at a time when &quot;we are trying to get a lot of stuff done.&quot;

&quot;We weren't troubled by the policy.
We were troubled by the controversy it caused,&quot; Scully said in an
interview. &quot;We want to get off to a friendly, happy, bipartisan start of
the year. This clearly wasn't doing it.&quot;

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>A White House official said the
president's aides were aware of the agency's latest decision and supported it.</span></font></p>

The pivot delighted senators and House
members of both political parties, along with outside consumer health
lobbyists, who had said the rule might impede the ability of some of the
nation's neediest patients to get rapid care when they need it.
&quot;Hallelujah!&quot; said Ron Pollack, executive director of Families USA, a
liberal health care lobby, who had said late last week that opponents were
preparing to contest the policy in federal court.

Sen. Bob Graham (D-Fla.), who sponsored
the emergency room protection and had been preparing to ask for the Senate vote
last night, praised the administration for changing its position.
&quot;Returning to the original standard will not only protect coverage for
Medicaid patients, it will save lives,&quot; Graham said. Sen. Edward M.
Kennedy (D-Mass.) was more pointed, saying in a statement that &quot;it is
unconscionable that the administration would have issued and defended this
policy in the first place.&quot;

The reversal ends a brief, and unusual,
episode in the history of Medicaid, a program shared by the federal government
and states that provides insurance to 37 million poor or disabled people. The
rule had the potential to affect as many as 23 million Medicaid patients who
are required by states to belong to health maintenance organizations or other
forms of managed care.

Already, states are permitted to restrict
payments for use of emergency rooms by people under &quot;fee for service&quot;
Medicaid, in which patients choose whatever doctors they want. But under a 1997
law, intended to protect the increasing proportion of Medicaid patients in
managed care, states must pay for emergency room services whenever a
&quot;prudent layperson&quot; could reasonably think they have a true medical
emergency. The rule, issued in late December, reinterpreted that law.

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The change was odd because the nation's
governors and Medicaid directors had not requested it, even though they lobby
often for other kinds of freedom to run their Medicaid programs -- and many of
them lately have been leaning hard, and unsuccessfully, on the administration
for financial help with Medicaid deficits.</span></font></p>

Gregory A. Vadner, vice chairman of the
National Association of State Medicaid Directors, said the reversal would have
little practical effect because states had not begun planning to restrict
emergency room use based on the administration's rule. &quot;Really, in the big
scheme of things, I don't think it will be something that all the states will
be greatly disappointed about,&quot; said Vadner, Missouri's Medicaid director.

When members of Congress began to protest
last week, administration officials defended their decision by saying their new
policy would create equal rules for all Medicaid patients, regardless of
whether they were in managed care. The administration also said the rule was an
attempt to curb reliance on emergency rooms for routine care that is more
efficient -- and economical -- for them to get in doctors' offices.

In yesterday's letter to Senate Finance
Committee Chairman Charles E. Grassley (R-Iowa) and the ranking member, Sen.
Max Baucus (D-Mont.), Scully said the administration wanted to work with
Congress to find other ways of discouraging unnecessary use of emergency rooms.

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