Monday, October 10, 2005

MHA speaks out against DHS interpretation of new law on ER use

From the Minnesota Hospital Association's "The Advocate" publication:

Concerned about the state's interpretation of new legislation aimed at curbing Medicaid emergency room payments for "convenience" level care, MHA staff and several MHA members have been speaking to Department of Human Services (DHS) officials about delaying and changing how it proposes to implement the law. The legislation was prepared to save the state approximately $3 million over the biennium. (With the loss of federal matching dollars, hospital payments are expected to be reduced by nearly $6 million.)

On Sept. 16, DHS shared a draft provider bulletin that first raised concerns about how the department was planning to implement the new law, effective Oct. 1. Rather than focusing exclusively on the issue of convenience care - which was what was addressed in legislation - the bulletin also delved into urgent-vs.-emergency care.

Speaking on Sept. 16 with Chris Reisdorf, DHS' manager of benefit policy, MHA staff and several finance, billing and coding representatives from member hospitals shared two major areas of concern. First, EMTALA requires that anyone presenting in the emergency room must be treated as an emergency; and second, hospitals would have difficulty classifying treatment delivered as "emergency" or "non-emergency" retrospectively through billing codes. Members encouraged DHS staff to discuss EMTALA requirements with the Joint Commission on Accreditation of Healthcare Organizations, to analyze their claims database to quantify the problem and clarify usage of the new triage code.


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