Physicians File Suit to Prevent Washington State Plan That Classifies More Than 700 Diagnoses as "Non-emergent" for Medicaid Patients

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American College of Emergency Physicians (ACEP)

Sep 30, 2011, 09:39 ET

SEATTLE, Sept. 30, 2011 /PRNewswire-USNewswire/ -- Emergency physicians in Washington State today filed suit in the Superior Court of Washington for Thurston County against a state plan that would limit payment for Medicaid visits to three "non-emergency" visits to emergency departments each year and classify more than 700 diagnoses as "non-emergent," including chest pain, abdominal pain, miscarriage and breathing problems.

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"This list of non-emergent diagnoses puts patients in danger and unfairly targets the poor and those in most need of care," said Dr. Stephen Anderson, president of the Washington Chapter of the American College of Emergency Physicians. "We understand that our state Medicaid office is working with 19 other states to develop this policy. If this plan goes into effect, other states will certainly follow suit."

The Washington Chapter of the American College of Emergency Physicians said the basis for the suit is multi-factorial and includes:

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.
The state has violated the requirements that this be a collaborative process as outlined by the legislature.
The state has violated the requirements that this be a list of non-emergent diagnoses as outlined by the state legislature.
The state has misconstrued the ability to bill patients for services. Federal law prevents physicians from meeting Medicaid requirements for billing patients through EMTALA, and state law blocks hospitals from billing under charity requirements.
The state is violating the federal Prudent Layperson standard by applying it to managed care patients.

"The average number of emergency visits for Medicaid patients affected by this requirement is about 4.5 visits per year, not the 30 plus that the state eludes to," said Dr. Anderson. "Physicians in the state have offered to work with state officials to come up with a list of truly non-emergent conditions. We truly want to work together to help reduce health care costs, but we must protect patients from harm."

Washington ACEP represents over 650 emergency medicine physicians and is a chapter of the American College of Emergency Physicians, a national medical specialty society representing emergency medicine. WA/ACEP is committed to advancing emergency care through continuing education, research and public education.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

http://www.washingtonacep.org/

SOURCE American College of Emergency Physicians (ACEP)