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ERs refusing care

One of my CFIDS mailing lists passed on this article... US Senator Questions Policy on ER Care for Poor

The Department of Health and Human Services is undercutting a law that allows Medicaid patients in HMOs to use the nearest hospital emergency room if a "prudent layperson" would consider the ailment a medical emergency, according to the Florida senator who crafted the legislation.

"The new HHS policy appears to allow health maintenance organizations and other managed care organizations to deny low-income mothers, children, seniors and individuals with disabilities access to needed services in the event of an emergency, and/or restrict the emergency rooms in which they could acquire the care," Sen. Bob Graham (D-FL) wrote in a letter to President Bush Thursday.

Graham, as part of the massive 1997 Balanced Budget Act, included language requiring coverage of emergency room care under the prudent layperson standard for patients enrolled in both Medicare and Medicaid managed care plans.

But on December 20th, Federal Medicaid Director Dennis Smith wrote a letter to Medicaid directors in every state to inform them that the Centers for Medicare and Medicaid Services is removing the requirement that patients be allowed to use the nearest emergency room. And the agency is also removing the requirement that plans pay for hospital stays arising from emergencies, even if a beneficiary has used up the number of days allowed under the program.

"We believe that the limitations on amount, duration and scope regarding emergency services in the state plan will apply to managed care enrollees as well as all other beneficiaries," the letter said.

Graham said this directly conflicts with the law passed by Congress and signed by President Bill Clinton.

"The point of Congress enacting the prudent layperson standard was so that individuals would not be denied needed emergency care by arbitrary HMO network and prior-authorization restrictions," the senator wrote. "This letter raises questions about these statutory protections for patients, and may actually eviscerate them."

So let me get this straight. Clinton enacted a law that said that anyone who a "prudent layperson" believed needed care could use the Emergency Room... to keep HMOs from excluding people.
And now the Department of Health and Human services is saying that this means they can exclude people because of this? That’s a bunch of BS. Since when do low-income mothers, children, seniors, and individuals with disabilities not need emergency care? Wouldn’t you think the Dept of health and human services would be trying to take care of this group of people?

I hope that if I ever go to the emergency room with a real emergency, they don’t look at me and say "she doesn’t look sick, send her away". (see Invisible Disabilities)


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I heard Ari talking about this on CNN yesterday. This is not a question as to whether or not people can be seen at the emergency room. This is a question of who is going to pay...that’s it! People can still go to emergency rooms if they want to, but they’re trying to discourage people from going unless it is a true emergency. It’s expensive to run an emergency room and it brings costs up when folks go to the emergency room when they really could have gone to a regular doc. That’s all! smile

Government. Hmph! All we ever hear is about how exorbitant the cost of medical care is, and how they are going to try to make it afforadable for EVERYONE; but instead, they go and screw with it some more, making it even more difficult.

Some of the people who go to ER’s rather than a doctor’s office do it because no doctor will take them without insurance; and some doctors don’t even take medicaid patients! Sometimes, people have no choice BUT to go to an ER when they’re sick, even when it’s not a true emergency.

Just my thoughts. smile


Hmmm. This all sounds very odd to my perspective, which is that of a country where the government operates hospitals (separate from the private hospitals where one really has to have insurance/and where the quality of service is a lot higher) where any citizen can present his identity card as proof of citizenship, and receive government subsidised treatment.

For a first world country the States really seems to have a positively barbaric approach to basic medical care.

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