Washington State Medicaid Implementing Limits On Emergency Department Care

Starting April 1, 2012, the Washington State Medicaid program will stop paying for emergency room care for beneficiaries with non-urgent conditions, such as common infections, mild burns, strains, and bruises. If an enrollee comes to an emergency room seeking care for conditions deemed non-urgent, or “not medically necessary” to treat in an emergency room setting, the state’s Medicaid managed care organizations (MCOs) will pay the emergency room $50 to conduct a screening for medical necessity under the provisions of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and then refer those patients not meeting the . . .