Bush reverses Medicaid decision

Associated Press

WASHINGTON — Reversing course, the Bush administration said it will maintain patient protections in Medicaid that require easy access to emergency rooms.

The administration told state Medicaid directors last month that they could put limits on emergency room visits for patients enrolled in health maintenance organizations and other managed-care programs.

That reversed rules, in place since 1997, that required states to pay for emergency room visits as long as a "prudent layperson" would have considered the situation a medical emergency.

The 1997 patient protections were created when Congress gave states the power to put Medicaid participants into cost-cutting managed care without getting special permission.

Some 40 million poor and near-poor people are insured through Medicaid, and more than 55 percent of them are in some type of managed care.

When news of the change became public, Democrats in Congress and others complained that the plan eviscerated the rights of patients. The administration initially defended the change, saying it was simply letting states put the same limits on its managed care patients as they did on others in Medicaid.

Five states limit the number of emergency room visits for Medicaid beneficiaries who are not in managed care, an effort to encourage them to see their primary care doctors when possible. Primary care doctors are better equipped to administer preventive care, and treatments are less expensive. These states wanted to put similar limits on people in HMOs.

The Department of Health and Human Services' December letter to states said they could do just that. But last week, the agency changed course.

Tom Scully, administrator of the Centers for Medicare and Medicaid Services, said in a letter that the change was being rescinded.

"We heard concerns ... that the policy, while well-intentioned, may have some unintended consequences and could potentially results in some restriction of payment for true emergency care for Medicaid beneficiaries," Scully wrote Sens. Charles Grassley, R-Iowa, and Max Baucus, D-Mont., the chairman and top Democrat on the Senate Finance Committee.