Washington Docs Sue State over ED Visit Limits
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"Emergency physicians in Washington are suing that state's health department over a new law that limits the number of "nonemergency" emergency department visits that Medicaid will cover. The Washington State Health Care Authority recently notified Medicaid beneficiaries that starting Oct. 1, Medicaid will pay for no more than three nonemergency visits to emergency departments annually per beneficiary. Limiting emergency room visits is illegal, according to the lawsuit, which was filed by the Washington branch of the American College of Emergency Physicians (ACEP). Washington's new law also would reclassify 700 diagnoses as "nonemergent" conditions, including chest pain, abdominal pain, miscarriage, and breathing problems, but ACEP is arguing that many of the codes represent true medical emergencies and should be covered by Medicaid, no matter how many times the patient has visited an ED during the year. "This list of nonemergent diagnoses puts patients in danger and unfairly targets the poor and those in most need of care," said Stephen Anderson, MD, president of the Washington Chapter of the ACEP, in a press release. The Health Care Authority spent nearly $98 million last year on 327,965 emergency department (ED) visits for Medicaid patients, according to a Sept. 22 press release. I suspect that Washington State will find difficulty with this plan being implemented as it appears to violate the Medicaid Comparability requirement: |
Washington State's plan to allow three ER visits a year excludes:
"children who are in the foster system or living with relatives or other caregivers. Nor will it apply to patients brought in by ambulance, police, or emergency medical technicians; visits for mental health diagnoses or for clients seeking detoxification services; or for visits that result in inpatient admission, emergency surgery, or admission for observation."
Washington State Supreme Court's opinion in Jenkins v. Wash. Dep't of Soc. & Health Servs., 160 Wn.2d 287, 157 P.3d 388 (2007) was a case in which people who had personal care providers paid through the Medicaid program were docked 15% of their assessed hours when they lived with their care providers. The Court ruled that this violated the Medicaid's Comparability rule, "because some recipients were treated differently from other recipients where each had the same level of need." Id. at 297 (citing Schott v. Olszewski, 401 F.3d 682, 688-89 (6th Cir. 2005)
Federal Medicaid law 42 USC § 1396a(a)(10)(B) "Requires medical assistance made available to categorically eligible individuals to be “no less in amount, duration, or scope than the medical assistance made available to a medically needy recipient."
Washington State's budget plan is one that would have no limit to ER visits imposed for children who do not live with a parent, or for those with substance abuse and/or psychiatric diagnoses---children who live with their parents would conceivably have the same needs as those who do not. There are medical conditions which are chronic and require the same level of care, as addiction and psychiatric diagnoses.
It will be interesting to see if these proposals to cut the State Medicaid budget which seem to determine that children and adults with comparable needs be treated differently based on place of residence and diagnosis; while ignoring medical necessity criteria.
"Washington's new law also would reclassify 700 diagnoses as "nonemergent"
conditions",including chest pain, abdominal pain, miscarriage, and breathing
problems." (MedPage)
I am not a doctor, paramedic, or nurse, but these four symptoms can be indicative of potentially fatal risks if I am remembering my Red Cross CPR/First Aid certification training...
note: the Medical News story says it is the State of Washington's Heath Department that is being sued; it is the Department of Social and Health Services, not the Health Department that administers the Medicaid program, and is being sued.
I could not access the Jenkins case itself online, I obtained the information from the case link below which cites and quotes the Jenkins ruling.
http://wa.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20110209_0000367.WWA.htm/qx
http://seattletimes.nwsource.com/
photo credit
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| hat tip: KevinMD |
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