We will be having further conversations with Ms. Tavenner, with whom we have been impressed, about Medicaid and prudent layperson. We also plan for ACEP leadership to meet soon with Cindy Mann, who is the Deputy Administrator of CMS. We have invited Ms. Tavenner to speak at ACEP’s Leadership & Advocacy Conference and she is considering our invitation. We are encouraged by CMS’s recent action in blocking California from charging Medicaid patients for emergency department visits with a stated rationale that “it is inconsistent with the statute.” We are hopeful of persuading CMS leadership to use a similar rationale in enforcing prudent layperson in responding to certain states’ actions. However, in light of the severe budget challenges of numerous states, and the significant political pressure to cut Medicaid, it may be necessary for us to have conversations with more senior officials at the Department of Health and Human Services and make an appeal to health policy advisers in the White House to support a strong CMS position.
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ACEP News: Vol 31 – No 03 – March 2012Outreach to Capitol Hill
We are following up with Sen. Cardin and Rep. Stark to urge them to seek a satisfactory response to their inquiry from November. We also intend to facilitate meetings with other key members of Congress who we believe have special interest or influence on Medicaid from an emergency medicine perspective, some of whom are from the states of Washington and Tennessee.
We are hopeful these members of Congress will support our requests to the Obama Administration and CMS to be more helpful on Medicaid. Depending on our discussions, we may request a Congressional hearing or GAO report focusing on the effects on patient access to care and effects on health for Medicaid recipients due to cuts and restrictions implemented by states. We will also emphasize the effect of state Medicaid reductions on “dual eligibles,” since 21% of all Medicare beneficiaries have dual eligibility for Medicaid.
At our Leadership & Advocacy Conference in May, one of the principal “asks” and matters of discussion in visits on Capitol Hill between our members and Congress will be support for Medicaid and the prudent layperson standard. Please try to attend the Leadership & Advocacy Conference, May 20-23, in Washington, DC. Registration is available now at www.acep.org/LAC. We need a strong turnout this year to be most successful in combatting this threat. We also need every member of ACEP to donate generously to NEMPAC, now more than ever, during this election year.
State Efforts
At the point of the spear in this crisis is the State of Washington, although Tennessee and some others are close behind. ACEP and the EM Action Fund have provided funding to the Washington chapter of ACEP for legal action against the Washington Health Care Authority. Our Washington chapter has engaged its state medical society and other allies in the effort to stave off caps on the number of Medicaid visits and reimbursement for emergency care. ACEP has provided this chapter and other chapters significant amounts of information about Medicaid and approaches to address this issue. There is also significant information posted on ACEP’s website. We will continue to be a resource to our chapters and to others who are fighting these battles in their own states, developing and providing them with talking points, potential strategies, and other resources.
Enlisting Allies
There are various organizations we plan to engage to try to develop a collaborative approach that would give us a better chance at success. We intend to have further discussions with the AMA and reach out to the National Medical Association. The American Academy of Pediatrics and possibly some other specialty societies may also prove to be good allies. We are encouraging our chapters to work with their state medical societies and state hospital associations. We will be having discussions at the highest level with the American Hospital Association and the Federation of American Hospitals. We will try to enlist support from organizations that are advocates for consumers, such as Families USA and AARP. In addition, there may be some religious organizations such as Catholic Charities USA that may be helpful allies since they provide services to the Medicaid population.
Media Campaign
Much of the media coverage these days is negative concerning Medicaid. It is our goal to try to gain support for the prudent layperson standard, as well as to educate reporters about the needs of the Medicaid population for access to care and the effects of bad policies on emergency medical care. Some of these media efforts include contacting influential health reporters at major media entities like The New York Times and USA Today; conducting a public opinion poll on Medicaid; doing focus group testing to guide a national media campaign; launching a letters-to-the-editor campaign through ACEP networks and allies; buying radio advertising around the Leadership & Advocacy Conference; obtaining media interviews for ACEP leaders; and coordinating with ACEP chapters to support media activities in states where Medicaid is under attack.
Research
We want to encourage data collection and research to support our advocacy on Medicaid. We will proactively encourage research and publication of papers by the Urban Institute, the Commonwealth Fund, RAND, Kaiser, and others. If Medicaid cuts are allowed to stand, it will be important to measure how they affect patients’ access to care, ramifications on overall health of the Medicaid population, and any negative effects on the emergency medical system.
Legal Challenges
We will continue to support, to the extent practicable, legal challenges mounted by our chapters, our members, and others in health care in the various states. We will get involved as an amicus party in federal and state courts where appropriate Medicaid cases are on appeal. It may also be necessary or appropriate at some point for ACEP to work with our members to bring a class action lawsuit or more targeted legal action against the federal government. The legal issues will vary from state to state depending on how state laws, regulations, requirements for public hearings, and other factors come into play.
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