CMSBackround

CMS Rescinds Rule Limiting ED Access

Background Information
On December 20, 2002, the Center for Medicare & Medicaid Services sent a letter to state Medicaid directors rescinding a safeguard provided by the Balanced Budget Act of 1997 which required Medicaid plans to provide coverage for emergency services meeting the "prudent layperson" standard. Under this scenario, the responsibility falls upon the state to determine how to handle Medicaid patients in the ED. Practically speaking, a state could limit the number of ED visits in a year, for example. Since EDs would still have to adhere to the EMTALA regulations, this action would equate to more of the financial burden having to be assumed by the health care facility. The rule had the potential to affect as many as 23 million Medicaid patients whom states require to belong to health maintenance organizations or other forms of managed care.

ENA's Letter to Administrator Thomas A. Scully