On November 10, 2011, Thurston County Superior Court Judge Paula Casey enjoined application of a new Medicaid policy limiting coverage for hospital emergency care.

The policy rests on a list of more than 700 diagnoses developed by the Health Care Authority (HCA) that it considers not to be emergencies, and for which it will limit coverage to three visits per year. A group of provider associations, led by the Washington Chapter of the American College of Emergency Physicians, challenged the new policy on a number of grounds. The providers, represented by Mike Madden and Megan Grembowski of Bennett Bigelow & Leedom, presented evidence that HCA’s list of non-emergency diagnoses includes nearly 200 conditions that, according to the medical study that HCA used to develop its list, always require emergency care, and that it would have excluded coverage for children for conditions that frequently lead to hospitalization. Judge Casey ruled that the policy was invalid because the state failed to follow proper rulemaking procedures. As a result, the state will be required to back up, publish a notice of proposed rule-making and hold public hearings on the new rule.

If you have any questions regarding this Client Alert, please contact Michael Madden or Megan Grembowski at 206-622-5511.