A recent judicial decision has prevented the State’s implementation of a controversial policy that would limit payment for Medicaid patients to three “non-emergency” visits to emergency departments each year.  The State asserted that implementation of the rule would result in significant cost savings for the State by better directing non-emergent uses to primary care providers.  Opponents of the rule are concerned that the policy will endanger Medicaid enrollees.  The rule included in the definition of “non-emergency” visits many truly emergent conditions such as chest pain, abdominal pain, miscarriage, and breathing problems.

Washington physicians and hospitals, including the Washington Chapter of the American College of Emergency Physicians (WA/ACEP), the Washington State Medical Association (WSMA), the Washington State Hospital Association (WSHA), and Seattle Children’s Hospital, filed the lawsuit to prevent implementation of the State’s policy.  On November 10, 2011, a superior court judge halted the State’s implementation of the policy and found that the State failed to follow proper rulemaking procedures.  Under the ruling, the policy may not be implemented until formal rulemaking is complete.  The formal rulemaking process will include public hearings and public comments before implementing the new policy.  The judge did not make a ruling regarding the content of the policy.

To read the Washington State Hospital Association’s article on this topic click here.