Medicaid payments for 'unnecessary' ER visits safe for now

Washington state has pushed the pause button on the restrictive Medicaid emergency room policy that would have stopped payment to hospitals for roughly 500 "nonemergent" conditions on April 1.

Acknowledging increasing support for a more moderate approach to reducing ER visits, Gov. Chris Gregoire (D) on Friday suspended the policy until state budget negotiations conclude, reported The Seattle Times.

Meanwhile, emergency room physicians and hospitals proposed an alternative policy, which focuses on case management of frequent ER users, limits on narcotic prescribing, real-time tracking of ER visits and appropriate primary care follow-up.

The House budget plan now includes this alternative approach to controlling costly emergency care, according to a statement yesterday from the Washington State Medical Association (WSMA), which praised the governor's move.

Voicing its support for a less-severe Medicaid policy, the American College of Emergency Physicians last month spoke out against basing Medicaid denials on final diagnosis. Instead, the society is pushing for a national "prudent layperson standard" that would require health plans to cover ED visits based on an average person's belief that he or she may have a medical emergency, FierceHealthcare previously reported.

For more information:
- read the Seattle Times article
- here's the WSMA statement (.pdf)

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