The Washington state chapter of the American College of Emergency Physicians has filed suit against the Washington State Health Care Authority, seeking to stop implementation of a new policy under which Medicaid would pay for only three nonemergency visits a Medicaid beneficiary makes to a hospital emergency department each year.
Washington state sued over Medicaid ER limits
According to the lawsuit (PDF), the policy—which takes effect Saturday—is illegal because the agency failed to follow its own rulemaking procedure. The group asserts that the agency failed—as directed by the state Legislature—to collaborate with the state hospital and medical associations to identify conditions that require emergency treatment. In addition, according to the suit, the policy's list of diagnostic codes that wouldn't be covered includes codes for conditions that, "according to medical evidence and reasonable medical judgment," require emergency treatment, and the policy doesn't follow federal and state laws governing coverage reductions.
"We understand that our state Medicaid office is working with 19 other states to develop this policy," said Dr. Stephen Anderson, president of the Washington ACEP chapter, in a news release. "If this plan goes into effect, other states will certainly follow suit."
On Sept. 9, the Washington State Hospital Association and the Washington State Medical Association, and the state chapters for ACEP, the American Academy of Pediatrics and the American College of Physicians wrote a joint letter (PDF) to the Washington State Health Care Authority protesting the new policy as well as its timing, the process by which it was developed and its scope—in particular, its inclusion of children ages12 and younger.
"We should focus on the areas where we have agreement, recoup those savings and then work together to find other ways to reach the required savings while not jeopardizing patient care," the organizations said in the letter.
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