Contact your Legislator
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Sample Letter To Your Legislator
We urge you to contact your legislators about this matter. Use the draft letter below to make your legislators aware of the fact that the list as it stands will put many of their constituents at risk. Please feel free to add your own text to personalize your letter.
Dear Honorable (Enter Legislators First and Last Name),
As an Emergency Physician working in the Emergency Department at (Facility/ED name), I am writing to express my concern about the actions of the Health Care Authority (HCA) and ask for your assistance in correcting a very bad policy. As part of solving the budget crisis in May 2011, the legislature enacted a requirement that the HCA develop a list of “non-emergent” diagnoses in collaboration with physicians and hospitals. The goal of the list was to limit Medicaid patients to three “non-emergent” emergency department visits per year. Unfortunately the HCA has unilaterally created a list of so-called “non-emergent” visits that includes diagnoses that are clearly emergencies and that if left untreated could lead to more severe illness, disability, and even death. This puts the patients of the state, including your constituents, at risk. Following are the major concerns of emergency physicians statewide:
The list of 'non-emergent' diagnoses is overly broad and includes hundreds of true emergency diagnoses. The legislature instructed the HCA to create a non-emergent list. The list of diagnoses proposed stands at over 700 conditions and includes 200 diagnoses that are 100 percent emergent based on the data the HCA provided and relied upon. These conditions include chest pain, shortness of breath, miscarriage with hemorrhage, asthma exacerbation, and others that are universally agreed upon to be emergent by experts in the field. As such, they should never have been included in the initial list, but erroneously were. When this was identified to the HCA, they initially agreed to remove them, but then reversed their course.
This list puts some of our sickest patients in danger – including children and those with the least access to health care. Children with asthma, elderly with chest pain, and pregnant young women will be those that the state puts at risk. This process discourages those with real emergencies from seeking care and is extremely dangerous.
The HCA has failed to collaborate on this process as required. The process was mandated to be collaborative by the budget proviso passed by the state. Unfortunately, the HCA has failed to meet this requirement. This lack of collaboration, in concert with the fact that HCA has unilaterally decided upon the list, capriciously added children to those at risk, and refused to even consider the recommendations of those that provide the safety net for our most endangered patients is highly concerning. We expected to work closely with state officials to come up with a list of truly non-emergent conditions. But we are not willing to sacrifice patient safety and many of these cuts pose a dangerous and significant threat to the safety of our patients.
The state is violating the federal and state legal requirements of “prudent layperson”. HCA made it clear at their last meeting that they will be applying a retroactive review to the managed care side of Medicaid. Congress required prudent layperson to be included for all managed care. This prohibits a retrospective review process from being done. This reckless attempt to apply it to this population is likely illegal.
Paramount to this entire discussion is access to care. There currently exists a critical shortage of primary care physicians and clinics that will see Medicaid patients. For many of these patients, the only access to care is through the ED. Rather than limiting their access with the HCA’s “non-emergent” list, we ask that you work with us to provide resources for follow-up care and case management; so that we may educate our Medicaid patients to prevent future “non-emergent” visits.
Emergency physicians have been the safety net for healthcare for the past forty years and we are proud to do so. Our opposition to the current proposal is another example of our desire to protect our patients from a dangerous practice that unfairly punishes the most vulnerable in our society.
We are here to be of assistance and improve access to care and coordination of care, but cannot support this capricious and egregious process. I encourage you to join us in advocating for the repeal of this legislation and move forward with a more productive and appropriate process; I would very much appreciate a response. Thank you for your time.
Please feel free to contact me at anytime if I can be of any assistance.
Sincerely,
Name, Title
Facility/ED Name
Contact Information
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