2004 Session

Budget Amendments - SB30 (Committee Approved)

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Emergency Room Usage by Medicaid Clients (language only)

Item 322 #4s

Item 322 #4s

Health And Human Resources
Medical Assistance Services, Department of

Page 248, after line 17, insert:
"G.  The Department of Medical Assistance Services shall study the degree to which hospital emergency rooms are being used by Medicaid fee-for-service clients for non-emergency care, and identify actions that could be taken to limit inappropriate use of this treatment setting.  In conducting its review, the Department shall: (i) assess recent trends in emergency room use by Medicaid fee-for-service enrollees; (ii) estimate the incidence of Medicaid clients using the emergency room for non-emergency care; (iii) identify effective actions taken by the HMOs participating in the Department’s managed care program as well as other state Medicaid programs to limit inappropriate use of the emergency room; (iv) consult with physicians and hospitals in assessing and developing programs that direct patients to primary care settings; and (v) recommend actions that can be taken to ensure emergency room usage by Medicaid fee-for-service clients is appropriate and medically necessary.  The Department shall report its findings and recommendations to the Governor and the Chairmen of the Senate Finance and House Appropriations Committees by November 1, 2004."

(This amendment requires the Department of Medical Assistance Services to assess the extent to which fee-for-service Medicaid clients are using emergency rooms for routine clinic services and recommend appropriate measures if necessary.)