FY ’06 budget may have bad news for EDs
If the current federal budget package is approved by the House of Representatives without significant changes, it could lead to decreased revenue for EDs, says Molly Collins Offner, MHSA, senior associate director of public policy in the Washington, DC, office of the American Hospital Association.
One of the potentially troublesome provisions concerns regulating the rate out-of-network hospitals and their EDs are paid by Medicaid managed care plans, with the effective date pushed back to fiscal year 2007.
"Many states have moved to Medicaid managed care for large chunks of their populations," Offner explains. "Typically, the state will contract with managed care companies, and they go out and find providers to be part of the network. Federal law says that they have to pay out-of-network care by the plan."
Access issues prompted change
This change was proposed because of access issues, she explains. The provision was put in to ensure these recipients could seek emergency services out of network and not have to pay for them. Under the new provision, Offner adds, "this would go up a notch, because it would require how these out-of-network hospitals are paid."
Nothing before directed the state or the plan on payment level, she says. "This would tie the payment level to the fee-for-service level for payment outside of managed care, and fee-for-service is a fairly low payment."
If the provision goes through as proposed, the impact on EDs will vary, Offner says. "A lot of states already handle things this way, but there is a handful where it’s an open, negotiated process," she says. "If it’s currently negotiated in your state, your ED will lose revenue."
A second potentially negative provision also deals with Medicaid. "In this section, they’ve granted states a fair amount of flexibility in how they set benefit packages for certain populations and charging premiums and copays that are new, and one package has to do with the ED," says Offner. The rationale is if you pay a copayment for nonemergent care in the ED, you may wait or go to a doctor the next day, she says. "We’ve argued against this provision because research has shown it delays care and results in bad debt for the most part," Offner says. "You just can’t collect it."
Offner: Fairly complicated process
The new provision sets up a fairly complicated process, she continues. "The Medicaid patient goes through a screening, and if it’s determined it is a nonemergency, the ED staff has to inform the patient they will be subject to a copay," Offner says. "They also have to work with the patient to find a referral and help with that process."
AHA officials argue that’s a huge burden of time and effort, she says.
"The argument we get back is you get paid for that, but we don’t think that will happen," she asserts. "What the states will likely do is look to that payment rate, see that a copayment is available, and you might actually see a drop in that payment rate over time."
The bill is awaiting final Senate approval.
Source
For more information, contact:
- Molly Collins Offner, MHSA, Senior Associate Director, Public Policy, American Hospital Association, 325 Seventh St. N.W., Washington, DC 20004. Phone: (202) 638-1100.