October 8, 2019

Upcoming Advocacy Resource on Prudent Layperson

With many states once again experiencing inappropriate denials and payment reductions that violate the prudent layperson standard, both from commercial insurers and state Medicaid programs, ACEP President Bill Jaquis tasked the State Legislative/Regulatory Committee with an objective to work with ACEP’s Reimbursement Committee and with the Emergency Department Practice Management Association to develop remedial model legislation to address the issue.

Knowing that state chapters may have opportunities in the upcoming legislative year to address these issues, committee members involved in this objective have expedited the work. Building on legislation that passed in Maine this year (and that borrowed concepts from legislation that passed in Missouri the year before), members are working on a model that would require board-certified, state-licensed emergency physicians to make review determinations.

Given the progress being made, it is hoped that work on the draft will be concluded not long after ACEP19. It should be noted that ACEP has numerous other resources on this issue. If you have questions, feel free to contact Harry Monroe.