Judge Rules Against Medicaid ER Visit Limit

Nov 10, 2011, 18:46 ET from Washington State Medical Association

SEATTLE, Nov. 10, 2011 /PRNewswire-USNewswire/ -- Today, in Thurston County Superior Court, Judge Paula Casey halted implementation of the state's controversial three emergency room visit benefit limit for Medicaid enrollees. The ruling, in favor of the Washington Chapter of the American College of Emergency Physicians (WA/ACEP), the Washington State Medical Association (WSMA), the Washington State Hospital Association (WSHA), and Seattle Children's, found the state failed to follow proper rulemaking procedures. Therefore, the current emergency rule implementing the three visit limit policy is invalid. The policy may not be implemented until formal rulemaking is complete.

Washington's physicians and hospitals filed the lawsuit to preserve access to emergency care for the state's most vulnerable residents. The state's plan would limit payment for Medicaid patients to three "non-emergency" visits to emergency departments each year. More than 700 diagnoses are classified as "non-emergent," including many truly emergent conditions such as chest pain, abdominal pain, miscarriage and breathing problems. Medicaid provides insurance coverage to many of our most vulnerable residents—pregnant women, infants, children, people with disabilities, and people living with mental illnesses.

"We are pleased that the judge ruled today in the courtroom and immediately stopped implementation of the emergency room benefit limit. The state's process has been arbitrary and capricious, and stopping it was clearly the right thing to do. 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," said Nathaniel Schlicher, MD, JD, WA/ACEP Legislative Chairman.

Now, the state will be required to go through a formal rule-making process including public hearings and public comments before implementing the new policy. "Washington State physicians, hospitals, and Medicaid patients themselves look forward to the chance to air their concerns about the denial of necessary emergency care," said Douglas R. Myers, MD, President of the Washington State Medical Association. Judge Rules Against Medicaid ER Visit Limit November 10, 2011 "Our hope is that the state devises a plan through the formal rulemaking process that reduces unnecessary emergency room care without endangering our patients," continued Dr Myers. "Under the current plan, patients who may be seriously ill or facing a life threatening situation may forego necessary medical care with disastrous consequences. We simply cannot sacrifice patient safety for the state's erroneously-classified 'non-emergency' list."

"Washington's physicians and hospitals will continue to work together and with the state with the goal of creating a safe but effective policy on unnecessary emergency room use. We must ensure access to quality care for Medicaid enrollees," said Scott Bond, President of the Washington State Hospital Association.


SOURCE Washington State Medical Association