Emergency Rooms & Medical Necessity: Questions & Answers from the Washington Health Care Authority on Limiting Payment for “Not MedicallyNecessary” in the Emergency Room Setting

January 5, 2012
The Washington State Health Care Authority (WSHA) plans to stop paying for hospital Emergency Department visits for Medicaid clients when it considers such visits to be 'not medically necessary' in the ER setting. The plans to use diagnosis codes for most clients and to conduct chart reviews for chronic users of the Emergency Department. This shift is designed to ensure that Medicaid enrollees seek primary care treatment where necessary instead of over-relying on the Emergency Room.
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