NH puts hold on ER policy under Medicaid expansion
By Kevin Landrigan, The Telegraph, Nashua, N.H. | |
McClatchy-Tribune Information Services |
The Legislative Fiscal Committee voted overwhelmingly to set aside the policy change until September because it's widely seen as a linchpin to control costs even as the state offers taxpayer-paid insurance to low-income adults who have no coverage.
"This is what is starting to drive me crazy about where we are headed right now," Morse said.
Enrollment in the program is set to begin
Health and Human Services Commissioner
"We all want to get this right the first time, and I'm committed to making this work because proper utilization of emergency rooms is a critical component," Toumpas said.
A key selling point made by Gov.
Hospitals in the state gave more than
Senate Majority Leader
Toumpas initially asked the House-Senate budget oversight panel on Friday to endorse his plan, which also requires final approval of the federal
A significant concern raised by health care executives was for those not going to an emergency room to have access to health care 24/7.
"We control emergency room usage; that's the whole point of this," Morse said. "This document is useless right now because of everything that comes in behind it. We have to stand up another service, seven days a week, 24 hours a day, to let people come in. I am not comfortable with what is going on."
Initially, those newly eligible for
"Naturally, hospitals are concerned that the MCOs might consider the subjective nature of the prudent layperson standard as a reason to deny payment for services," Ahnen wrote.
"If the state removes the subjectivity and applies 20/20 hindsight by looking at the final diagnosis versus the presenting symptoms or complaints, the provider has expended resources to care for the patient that may not be reimbursed," he wrote.
A coalition of advocates ranging from the
They said national studies have concluded only 10 percent of emergency room visits by
The same reports show those on
Denying
"Consequently, they may ration their care without regard to whether they should put off seeking medical care or in what context," they wrote.
Toumpas said he isn't concerned that the delay means the policy won't be in place when enrollment begins in six weeks.
"We will pay a flat member per month rate to these managed care organizations to provide care," Toumpas said.
"Until we get the language right, there's still going to be every incentive to ensure that every emergency room visit is justified. We're counting on the providers to collaborate with the managed care system so that clients receive the best, most cost- effective care."
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