Ruling knocks down Wash. state limits on Medicaid coverage of ER visits

[CAL/AAEM News Service]

Description: Description: Description: Description: CAL/AAEM: California
Chapter of the American Academy of Emergency Medicine

November 11, 2011

 

Ruling knocks down Wash. state limits on Medicaid coverage of ER visits

 

ModernHealthcare
<http://www.modernhealthcare.com/article/20111111/NEWS/311119985> 

 

A court ruling Thursday is forcing Washington state to temporarily repeal
rules that seek to limit Medicaid coverage of emergency room visits for
non-emergency care.

 

A Thurston County judge said the state did not follow proper procedures when
it established a three-visit annual limit. Officials with the state's Health
Care Authority said they are going to rework the proposal through proper
procedures and that the ruling from Judge Paula Casey did not address
whether the larger effort is legal.

 

"We remain under a legislative mandate to implement this limit and
contribute savings to help relieve the state's extreme financial crisis,"
said Health Care Authority Director Doug Porter in a statement.

 

The American College of Emergency Physicians has sued the state, arguing
that the rules put patients at risk. The group has noted that the list of
non-emergencies include chest pain and kidney stones, arguing that the rules
force people to self-diagnose.

 

The ruling will allow groups to air concerns about the issue in public
hearings.

 

"The state's process has been arbitrary and capricious, and stopping it was
clearly the right thing to do," said Nathaniel Schlicher, legislative
chairman of the Washington chapter of the emergency physicians group, in a
statement. "We continue to be interested in a truly collaborative process to
reduce unnecessary emergency room visits. We will not, however, stand by and
allow a policy damaging to Medicaid enrollees to take effect."

 

State officials implemented the rule a month ago, hoping to deter people who
overuse the emergency room. About 3 percent of patients exceed the
three-visit threshold in an average year, with a small group of clients
exceeding 100 visits in what state officials characterize as a quest for
drugs.

 

The state projected that it would save more than $30 million over a two-year
period.

 

 

 

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

 

 

Contact us at: calaaem.news.service1 at gmail.com

For more articles, visit our archives
<http://maillists.uci.edu/mailman/public/calaaem/> . 

 <mailto:somcaaem at uci.edu> To
<https://maillists.uci.edu/mailman/listinfo/calaaem>  unsubscribe from this
list, visit our mail server.

Copyright (C) 2011. The California Chapter of the American Academy of
Emergency Medicine (CAL/AAEM). All rights reserved.

CAL/AAEM, a nonprofit professional organization for emergency physicians,
operates the CAL/AAEM News Service solely as an educational resource for
physicians. Dissemination of an article by CAL/AAEM News Service does not
imply endorsement, agreement, or recommendation by CAL/AAEM News Service,
CAL/AAEM, or AAEM.

 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://maillists.uci.edu/mailman/public/calaaem/attachments/20111118/7deb8f08/attachment-0001.html 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: image/jpeg
Size: 25019 bytes
Desc: not available
Url : http://maillists.uci.edu/mailman/public/calaaem/attachments/20111118/7deb8f08/attachment-0001.jpe