Bill Would Move Medicaid Patients With Chronic Conditions Out of EDs

ACEP News
December 2009

By Terry Rudd
Elsevier Global Medical News
 

Some Medicaid patients with chronic illnesses would move out of emergency departments and inpatient beds and into more appropriate community care settings, under legislation unveiled in October.

The "Reducing Emergency Department Utilization Through Coordination and Empowerment Demonstration Program Act" (S. 1781) targets frequent ED visits and hospital admissions by Medicaid beneficiaries with chronic conditions such as asthma, chronic obstructive pulmonary disease, severe mental illness, and diabetes.

The act would support projects to coordinate care and community support services for those patients.

"Treating people repeatedly in emergency rooms instead of coordinating less costly preventive care ... [is a perfect example] of what is wrong with our nation's health care system," said Sen. Jeanne Shaheen (D-N.H.), the legislation's lead sponsor. The bill's cosponsors are Sen. Sherrod Brown (D-Ohio), Sen. Dianne Feinstein (D-Calif.), Sen. Frank Lautenberg (D-N.J.), and Sen. Robert Menendez (D-N.J.).

Beginning in fall 2010, the federal Department of Health and Human Services would spend up to $150 million to fund 5-year demonstration projects in up to 10 states. Health care providers would receive a share of any cost savings that the projects generated.

Under the proposed bill, multidisciplinary treatment teams of primary care and behavioral health providers would develop individualized care plans for Medicaid enrollees who have chronic illnesses. The Medicaid beneficiaries also would have access to care management teams composed of medical providers (physicians, physician assistants, or nurse practitioners), social workers, and community health workers. To support better coordinated care, the initiative would fund some services not traditionally covered by Medicaid.

Within a year of the 5-year project's completion, HHS would report results and recommendations to Congress.

The Senate Finance Committee hasn't acted on S. 1781, however, and no one has introduced companion legislation in the House of Representatives.

Rep. Linda Sanchez (D-Calif.) introduced a related bill earlier this year, the "DSH [disproportionate share hospital] Collaborative Care Network Pilot Program Act of 2009" (H.R. 3430). That legislation would create a Medicare pilot project to reduce emergency department use by building collaborative care networks for low-income and uninsured patients. That bill also has yet to be taken up by two House committees.

To read the full text of the bill, visit thomas.loc.gov/cgi-bin/query/z?c111:S.1781:.

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