The American College of Emergency Physicians Lauds CMS’ Action to Ensure Florida Complies with Prudent Layperson Standard

The American College of Emergency Physicians (ACEP) and Florida College of Emergency Physicians (FCEP) have sent a formal response to Marilyn Tavenner, the Administrator and Chief Operating Officer of the Centers for Medicare & Medicaid Services (CMS), supporting CMS’ planned hearing to address Florida’s restriction of emergency department use to six visits per year for Medicaid beneficiaries which ACEP asserts is a violation of the prudent layperson standard. ACEP calls the hearing notice “a welcome commitment of federal oversight of beneficiary protections.”

Alex Rosenau, DO, FACEP, president of ACEP, and Michael Lozano, president of FCEP, issued a statement:

“Florida’s action is a violation of the prudent layperson standard that may result in serious and potentially deadly outcomes. Its use of the six-visit limit is yet another example of states using short-sighted approaches to saving money that can hurt the very people they are supposed to protect. As CMS itself has stated, Medicaid beneficiaries use the emergency department at an almost two-fold higher rate than the privately insured, but that is not inappropriate given their generally poorer health. At least two studies found that the majority of emergency visits by non-elderly Medicaid patients were for symptoms suggestive of urgent or emergent medical problems.

“Emergency physicians strongly support Medicaid beneficiaries’ appropriate use of primary care, but the mismatch of supply and demand for primary care is expected to continue for quite some time. In the meantime, many Medicaid patients will continue to use the ER as a reliable source of care.

“Emergency departments will continue to serve as the safety net for millions of Americans and they should not be penalized when patients seek them for acute care needs.  At the same time, our members fully support CMS’ efforts to enroll and educate beneficiaries about convenient and alternative sites of care where they exist.”

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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