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Kentucky Chapter Averts Proposed Medicaid Change to Stop Paying for Non-Emergency Care in the ED

In late 2005, Kentucky Medicaid officials unveiled a proposal to stop paying for non-emergency care provided in emergency departments.  Through the efforts of the Kentucky Chapter of ACEP, state officials were educated on the problems with this proposal, ultimately leading them to scrap the idea.  As a result of their efforts, the chapter is now working with the state to explore better ways to control Medicaid spending without negatively impacting emergency care.

Below are excerpts from a January 2006 email from Barbara Reynolds, MD, FACEP about this issue and the Kentucky chapter's response.

"…the Medicaid office in KY requested a waiver from CMS which would allow an in-depth restructuring of how Medicaid funds were allocated. This addresses 6 basic areas, all of which I think outline potential improvements and hopefully some savings for the state. As you also know, that waiver has just been approved.
 
There was, in addition to the waiver, a stand alone Reg that was proposed late last fall. This is the one that has had everyone concerned and it stated that Medicaid would not pay for ED visits that were deemed retrospectively as not to have been emergent.
 
Bill Doll, lobbyist for the KMA… was able to schedule a meeting with Medicaid Commissioner Shannon Turner and several members of her staff. The meeting was held in late December and attended by Bill, myself, Bob Couch and Chris Pund representing KACEP. The Medicaid folks had been convinced that this Reg would save the state something like $50 million dollars annually. It also addressed what is often a common misconception that the cause of the Medicaid budget woes is Medicaid patients abusing the ED.
 
Our approach was that we certainly realized that there was a significant budget shortfall and there is a need to conserve Medicaid dollars. However we did not feel that this Reg would either solve the problem or provide the savings they projected. In addition, this Reg clearly contradicts both Prudent Layperson and EMTALA. We also pointed out that such a Reg would also discourage patients with true emergencies from seeking care for fear of being charged.
 
We said that although we did not feel that EDs were the cause of the problem, we, as emergency physicians, were very interested in being part of the solution. In that vein, we suggested forming a work group or task force to explore alternate ways to save money and discourage unnecessary use of the ED. We also asked that the Reg be withdrawn in favor of the waiver.
 
The day after this meeting, there was a public hearing on the Reg. There were only two people who testified, myself and Bill Doll. There was no testimony in favor of the Reg.
 
The Reg was formally withdrawn by the Commission last week. The Commission has requested that the suggested work group be formed and meet soon. I think this will take place some time in the next 3-4 weeks. This is a major step for us.
 
As to the copay, one of the tenets of the waiver is "cost sharing". Several ideas are proposed including Medicaid premiums, copays, etc. Whether there will be a copay or how it would be structured, has not been determined. At this time, it is felt that if it happens, it would be an add-on charge, not a deducted charge which is essentially a tax on providers. This is an area that is being worked on by the KMA and we are well represented.
 
I am delighted that we will be able to work closely with the Medicaid Commission on this topic which is crucial to both our patients and all emergency physicians. Needless to say, this will not be an easy job especially since the Commission is committed to not reducing the number of beneficiaries in the state. We will need to be very creative but I think there are avenues that have not been explored so I am hopeful we can make a difference.
 
Any ideas or advice you can offer is much appreciated.

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