State Advocacy Update

  • StateScan features news on key state issues, highlights examples of ACEP chapters’ advocacy efforts, links to ACEP advocacy resources for chapters, and provides access to the current text and status of bills of interest to emergency medicine from state legislatures across the country.


  • From the Chapters: Advocacy in Action

    Defending Access to Care and Fair Payment for Emergency Physicians

    A battle has raged in New York in March, after the release of a budget proposal by the governor's office that would essentially allow an insurer to pay providers any "amount that it determines is reasonable" for out-of-network emergency services. Emergency care providers are exempted from a provision in the bill that would pay other out-of-network fees at 70% of the usual and customary rate, thus leaving emergency physicians who find a payment from an insurer to be less than reasonable to seek recourse through what is likely to be an unwieldy and costly arbitration process.

    The New York chapter responded strongly to the proposal and has worked extensively with administration and legislative contacts to oppose it. The chapter was ultimately successful in getting language inserted into the Senate version of the budget proposal that could largely mitigate the impact on emergency physicians, by excluding from the proposal evaluation, management, critical care and observation services provided by an emergency physician when the physician charge is less than $1200.  The chapter sent a message to legislators to support the language in the Senate bill, and issued an action alert for members to contact their legislators.  The chapter's intense efforts paid off with inclusion of much more favorable language than originally proposed. See the story on the New York chapter web site for details.

    While the specifics of the New York proposal are unique, numerous chapters have faced similar battles before (with various degrees of success) in trying to combat efforts to give insurers greater control over how much is paid for emergency care. ACEP and chapters have developed materials to help other chapters address proposals related to private payer issues such as fair payment, balance billing and assignment of benefits through talking points, model legislation and other resources.


    Another State Seeks to Limit Payment for "Non-Emergency" Care in the ED 

    Meanwhile, Louisiana is now faced with a proposed regulation that would limit payment for emergency care to a nominal triage fee for any care deemed to be "non-emergency" care. The state would determine what is a non-emergency by using a list of more than 900 final diagnoses deemed by the state to be non-emergent.  The Louisiana chapter, along with other emergency medicine organizations, the state hospital association and the state medical association moved quickly to begin exploring various strategies to oppose the proposal, which is set for a public hearing in late April. The chapter has sent an initial comment letter to oppose the effort.

    Of course, other states have faced similar proposals related to cutting Medicaid payments for "non-emergency" care in the ED, most notably in Washington State. Resources developed by ACEP and the Washington chapter and others are available on a special page of the ACEP web site to help chapters facing this issue.  The resources include a CMS bulletin from January that acknowledges that Medicaid managed care must follow the prudent layperson standard and recommends alternative approaches to reduce truly unnecessary ED visits.  The bulletin mentions the alternative approach that was ultimately adopted in Washington, and in March the Washington chapter participated in a news conference to tout the successes of its seven "best practices" that were developed to reduce overutilization of the ED.  More information on the Washington success is available here.


    Around the Nation: Samples of State Legislation of Interest to Emergency Medicine

    Arizona SB1298  Would require case management services if a Medicaid member seeks care at an ED more than once in a 45-day period to educate the member regarding the proper use of emergency services.

    California SB1429   Legislative intent to bring parties together to reach compromise on MICRA reform. (Signatures have been collected to force a referendum that would overturn key MICRA protections.)

    Colorado SB16   Would require all freestanding emergency departments (not part of a community clinic located from than 25 miles from a hospital) to be owned and operated by a hospital within two years.

    Hawaii SB650   Would prohibit prescribing long-acting opioid painkillers in the ED and prescribing more than a seven-day supply of opioids other than long-acting painkillers.

    Idaho SB1329   Creates Idaho Time Sensitive Emergencies System of Care to include trauma, stroke and cardiac events.

    Illinois HB4335   Would require hospitals to provide patients placed into observation services with a notice within 24 hours after placement that the patient is not admitted and is under observation status.

    Maryland HB710   Would require establishment of program and procedures to reduce violence in health care facilities.

    Massachusetts SB1012  Would provide special liability protection for emergency care providers and providers of medical care in a disaster.

    Michigan HB4354   Would provide special liability protection for providers of EMTALA-mandated care.

    Minnesota SF2262   Would establish continuing quality improvement program through a statewide system for ST-EMI response and treatment.

    Mississippi HB547   Requires insurers to honor an insured's assignment of benefits for one year.

    New Jersey A2392   Would establish pilot program where physicians who follow established treatment guidelines are not subject to liability.  Injured patients would be compensated through a no-fault system.

    Ohio HB332   Would establish standards for opioid treatment of chronic pain and require  disciplinary action for failing to comply with those standards and procedures.

    Pennsylvania HB1907   Would require hospitals to provide notice to a patient of observation status and billing implications of that status.

    Tennessee HB482   Would require a physician in an ED to check the controlled substance database in overdose cases and to make certain reports, if appropriate.

    Utah SB261   Would repeal a law allowing ACOs to audit ER services to determine if care was non-emergent and to establish differential payment for non-emergency care.

    Vermont SB309   Would require the Dept. of Mental Health to establish protocols for individuals received in an ED during a mental health crisis.

    Virginia HB1232   Creates an acute psychiatric bed registry.

    Wisconsin AB447   Provides immunity for calling for medical help for a drug overdose.    


     Many more bills covering these and other topics can be found in the Bills of Interest section of StateScan. Bills are searchable by established categories and then by state. For questions, contact the ACEP State Legislative Office.   



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