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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