ER COVERAGE: ‘Prudent Layperson’ Bill Reintroduced
Backed by the nation's largest not-for-profit HMO, the sponsors of legislation that would impose the "prudent layperson" standard for reimbursement of emergency care resurrected their bill yesterday, the Miami Herald reports. Appearing with Access to Emergency Medical Services Act sponsors Sens. Bob Graham (D-FL) and John Chafee (R-RI) were Kaiser Permanente's Dr. Donald Parsons and Dr. Michael Rapp, president-elect of the American College of Emergency Physicians (Davies, 3/3). Rapp said, "If you have chest pain, should you take precious time to call your managed care plan for approval before going to an emergency department? Or should you take a chance and try to diagnose the severity of your own illness? If you don't make the right choice, you could get stuck with a big bill, or even worse, you could risk your health" (Leinwand, Tallahassee Democrat, 3/3). Kaiser instituted the prudent layperson standard in 1996. A company release stated, "When you or a loved one believe you have a life-threatening condition, the last thing you should worry about is whether or not your health plan will pay for the medical care you receive" (release 3/2).
All About Nuance
CongressDaily reports that Graham blasted GOP-sponsored HMO reform bills that "purport to impose" the prudent layperson standard, but that lack "important nuances and subtleties." Rep. Benjamin Cardin (D-MD), who is co-sponsoring the House version of the Graham/Chafee bill, said the House Republican's Patient Protection Act does not include "severe pain" as an allowable symptom for seeking ER care, and covers only "an initial screening -- not necessarily ... care needed as a result of a patient's condition." The Senate GOP managed care reform bill would cover only plans exempt from the Employment Retirement Income Security Act, leaving residents of the 18 states without a prudent layperson law unprotected (Rovner/Morrissey, 3/2). Noting that 32 states already have the protections in place, Rapp said, "This isn't breaking new ground" (Democrat, 3/3).
American Association of Health Plans President Karen Ignagni announced her group's opposition to the Graham/Chafee bill, saying, "Every provider group and specialty society has its particular mandate, but the sum total of all these would be higher premiums" (Herald, 3/3). Health Insurance Association of America spokesperson Richard Coorsh said, "Emergency room visits are routinely paid for. The issue has to do with non-emergent care. The issue is whether the after-care is paid for, after the initial screening and making sure the person is stable" (Democrat, 3/3).