Citing Medicaid Limits, ED Docs Sue WA State

John Commins, for HealthLeaders Media , October 4, 2011

Emergency physicians in the state of Washington have filed a lawsuit against a state plan to classify more than 700 diagnoses as non-emergent, and limit Medicaid reimbursements to no more than three non-emergent visits to the emergency department each year.

"The state has been mandated to try to save $72 million over the next two years, and this will clearly impact emergency care," Stephen Anderson, MD, president of the Washington Chapter of the American College of Emergency Physicians, told HealthLeaders Media.

"The list at the moment includes chest pain, hemorrhage during miscarriage, infections of the leg that can result in amputation, passing out for no reason, heart arrhythmia. It's frightening."

Anderson says the new restrictions could impact healthcare access for the poor and those most in need of care in at least 19 other states that have worked with Washington State to develop the policy, which went into effect on Oct. 1. "If this plan goes into effect, other states will certainly follow suit," he said.

The emergency physicians have asked a judge in the Superior Court of Washington for Thurston County to slap an immediate injunction on the new restrictions. In a media release, ACEP spelled out its concerns about the suit, alleging that the state: 

  • Has not implemented a rulemaking process that included stakeholder comments; yet the plan is being forced on hospitals and providers with no warning.
  • Violated the requirements that this be a collaborative process as outlined by the legislature.
  • Violated the requirements that this be a list of non-emergent diagnoses as outlined by the state legislature.
  • Misconstrued the ability to bill patients for services. Federal law prevents physicians from meeting Medicaid requirements for billing patients through the Emergency Medical Treatment and Active Labor Act (EMTALA), and state law blocks hospitals from billing under charity requirements.
  • Is violating the federal Prudent Layperson standard by applying it to managed care patients.
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4 comments on "Citing Medicaid Limits, ED Docs Sue WA State"

Julie Lohman (10/18/2011 at 6:46 PM)
Medicaid has allowed their clients to receive this kind of care for years - they are not introducing an approach that would ease these clients into the new culture - the patients and the hospitals are going to suffer radically for the culture that medicaid allowed -It could be interpreted that they errored and the patient and hospital will be punished.

Louise B. Andrew MD JD (10/8/2011 at 5:46 PM)
This is a blatant attempt to cut costs in order to meet a state budget, by circumventing federal "prudent layperson" law and forcing Emergency physicians to assume financial responsibility for screening indigent patients for emergencies. The state provides no other mechanism to do so. Other federal law (EMTALA) requires that it be done. So ED's are left as the safety net, which also must eat the costs. Attempting to frame this as a drug seeking or ED abuse issue is disingenuous at best and ill-informed at least. It will probably take a few out-of-hospital deaths of Medicaid patients with so called "non emergent" presenting complaints to make this issue public enough that the law will be changed legislatively, if the lawsuit is unsuccessful at toppling an unsound, fiscally motivated, and basically unconscionable piece of legislation.

Lisa Barber RN (10/5/2011 at 4:33 PM)
This program discriminates against poor and rural areas that have limited number of clinic physicians and no Urgent care clinics available. This proposal will cause patients needing care to wait until they are much sicker before seeking care and end up causing the tax payers more money. As the director of a rural emergency department, most patients we see frequently have psychiatric issues or have learning dosabilities and have difficulty understanding the difference between clinic care and emergency care. They only know they need help.




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