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ACEP Calls on the House to Pass Patient Protection Legislation

Washington, DC -- The American College of Emergency Physicians (ACEP) today called on the House to begin the long overdue debate on patient protection legislation, which includes the prudent layperson definition of emergency care.  ACEP applauds the inclusion of the prudent layperson standard in the bills introduced recently by House members, including the Health Care and Quality Choice Act of 1999 (HR 2824) introduced today by Representatives Tom Coburn (R-OK) and John Shaddegg (R-AZ) and the bipartisan bill (H.R.2723) introduced by Representatives Charlie Norwood (R-GA) and John Dingell (D-MI) last month.

"Patients should be able to access emergency care whenever and wherever they need it.  As emergency physicians, we strongly support provisions in these bills to protect patients from 'after-the-fact' claim denials of emergency care and prior authorization requirements that create barriers to care that can place the health of patients at serious risk," said Dr. John Moorhead, president of ACEP.  "Inclusion of the prudent layperson standard in both bills shows there is significant agreement among members of Congress to ensure that patients enrolled in health plans will not be denied emergency care coverage. This demonstrates a growing consensus that the prudent layperson standard of emergency should be a basic patient protection for all Americans.  The emergency physicians of this country and our patients call on Republicans and Democrats alike to take the steps necessary to pass meaningful patient protection legislation that includes the prudent layperson standard this year."

The prudent layperson standard, as originally introduced in the Access to Emergency Medical Services Act of 1999 (H.R. 904), has been included in several bills introduced in Congress this year, including the Coburn/Shaddegg and the Norwood/Dingell (H.R. 2723) health care legislation. The prudent layperson language included in both bills additionally conforms with the definition included in the Medicare and Medicaid portions of the Budget Reconciliation Bill signed into law in 1997 and also applied to all federal employees via executive order by President Bill Clinton last year.

"It is important that the House pass a bill that extends the prudent layperson standard as set forth in H.R. 904, to the approximately 161 million Americans with health insurance, unlike the health care legislation passed by the Senate (S.1344) last month, which only covered 48 million patients enrolled in self-insured health plans.  It is imperative that hard working Americans who pay for their health insurance be afforded the same emergency care protections as individuals enrolled in federal government, Medicare, and Medicaid health plans.  ACEP further calls on the House and Senate, once the House has acted, to reach a compromise that in no way diminishes the application of this standard," Moorhead added.

The Access to Emergency Medical Services Act of 1999 (H.R. 904) introduced in Congress this year by Representative Ben Cardin (D-MD) and Marge Roukema (R-NJ) established a uniform definition of an emergency based upon the prudent layperson standard.  Health plans would be required to cover emergency services if the patient presents with symptoms that a prudent layperson, possessing an average knowledge of health and medicine, could reasonably expect to result in serious impairment to the patient's health.  This bill also would guarantee coverage of emergency services based on a patient's presenting symptoms and not the final diagnosis.  This legislation further prohibits all plans from requiring as a condition for coverage, that patients obtain prior authorization from the health plan before seeking emergency care.  It additionally promotes quality cost-effective care by establishing a process in which the emergency physician and health plan work together to coordinate appropriate post-stabilization care or follow-up care.

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The American College of Emergency Physicians is a medical specialty society representing nearly 20,000 physicians who specialize in emergency medicine. ACEP is dedicated to improving emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state as well as Puerto Rico, the District of Columbia, and Government Services.
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