Judge Rules on Three ED Visit Limit

Last week a Thurston County Superior Court ordered a halt of the state’s controversial three emergency room visit benefit limit for Medicaid enrollees and opens a door for some collaborative discussions.

The judge’s ruling – in favor of the suit filed by Washington Chapter of the American College of Emergency Physicians (WA/ACEP), the WSMA, the Washington State Hospital Association, and Seattle Children’s – found the state failed to follow proper rulemaking procedures and, therefore, the current emergency rule implementing the three visit limit policy, implemented October 1, is invalid.

The state’s attempt to limit payment for Medicaid patients to three “non-emergency” visits to emergency departments each year was based on more than 700 diagnoses classified as “non-emergent,” including many truly emergent conditions such as chest pain, abdominal pain, miscarriage, and breathing problems.

Now the state is required to go through a formal rule-making process including public hearings and public comments before implementing the new policy.

 

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