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State’s limits on emergency room use lifted after judge’s ruling

Post by Jordan Schrader / The News Tribune on Nov. 10, 2011 at 4:12 pm |
November 10, 2011 4:12 pm

Medicaid will resume paying for repeated emergency-room use after a Thurston County judge ruled against state government today.

It’s a $33 million blow to the already reeling state budget. But doctors say it’s good news for patients.

Joined by hospitals, doctors’ groups sued the state over a limit of three annual paid “non-emergency” visits that officials imposed this year on emergency rooms. The state and doctors bitterly disagreed on a list of more than 700 diagnoses that would count as non-emergencies, including nonspecific chest pain, shortness of breath, kidney stones and nonspecific congestive heart failure.

Superior Court Judge Paula Casey didn’t rule on the substance of the list but said the state failed to follow proper procedures in creating an emergency rule to implement it, both sides said.

Nathaniel Schlicher, associate medical director for the emergency department at St. Joseph Medical Center in Tacoma, said in a news release:

The state’s process has been arbitrary and capricious, and stopping it was clearly the right thing to do. We continue to be interested in a truly collaborative process to reduce unnecessary emergency room visits. We will not, however, stand by and allow a policy damaging to Medicaid enrollees to take effect.

Doctors said in the release the state would now have to go through a formal process including public hearings. Health Care Authority Director Doug Porter says he told employees to correct the agency’s procedures. He said in his own news release:

We remain under a legislative mandate to implement this limit and contribute savings to help relieve the state’s extreme financial crisis.

Lawmakers ordered $72 million in savings by cutting spending on repeat non-emergency visits, more than half of which would be federal money. State officials say 3 percent of Medicaid patients exceed three visits a year for the specified conditions and would be better off directed to primary care doctors.

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