Citing Medicaid Limits, ED Docs Sue WA State

John Commins, 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.
John Commins

John Commins is a senior editor at HealthLeaders Media.

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