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CMS taking measures to reduce nonurgent use of EDs, KY Medicaid implements cost sharing for such visits

Jan 27th, 2014

The Center for Medicare and Medicaid Services issued a bulletin of strategies they and other agencies will utilize to reduce nonurgent use of emergency departments.  CMS wants to "address unmet health needs as the underlying causes of high ED utilization." Specifically, CMS supports the expansion of urgent care and retail clinics, as well as increasing hours of operation for other primary care sites.  CMS also hopes to improve the health and access to care of those with mental health problems and "super-utilizers," or those with at least four ED visits per year.  

Moreover, CMS allows the use of cost sharing for nonurgent care provided in an emergency department to Medicaid beneficiaries.  As of January 2014, a Kentucky Medicaid beneficiary may be responsible for a cost sharing amount of $8 for nonemergency care received in an emergency department.  There are exemptions, including those for children and pregnant women, and there is no cost sharing for care that is deemed emergent.  This move, implemented by several other states already, is highly controversial.  There is no universal method to distinguish an emergent visit from a nonemergent visit.  Also, hospitals must be careful that their policies and billing procedures remain compliant with EMTALA requirements and do not impede treatment and services.  In Kentucky, many rural areas and a physician shortage mean that access to care is sometimes lacking, and the state ranks poorly on many health measures.  While cost sharing aims to reduce unnecessary and costly methods of care, we must be especially careful that Kentucky patients are still receiving the best medical treatment possible.  


Read the CMS bulletin here.

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