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ACEP Opposes the House Managed Care Bill and Calls on Congress to Enact Prudent Layperson Standard Consistent with the Balanced Budget Act

The American College of Emergency Physicians (ACEP) today stated its opposition to HR 2045, the "Patient's Right to Emergency Care Act of 1999," passed by the Employer/Employee Relations Subcommittee, because it proposes a weaker federal standard for coverage of emergency care for privately insured patients than the prudent layperson standard adopted by Congress for Medicare and Medicaid patients in the Balanced Budget Act of 1997.

In a letter to members of the Subcommittee, Dr. John C. Moorhead, president of ACEP, clarified the problems with the bill's language, which is basically identical to the House-passed bill in the 105th Congress, which ACEP opposed last year. The Subcommittee today passed the legislation onto the full House Committee on Education and the Workforce.

"The language in H.R. 2045, as currently written, undermines the intent of the 'prudent layperson' standard and provides those individuals covered by private managed care plans with less protection for coverage of emergency care than Congress provided to Medicare and Medicaid patients as part of the Balanced Budget Act, and subsequently afforded to Federal employees" said Dr. Moorhead. "The bill is seriously flawed in that it requires patients to meet a new and tougher federal standard for emergency medical coverage. The language of the bill creates loopholes for endless denials of claims and leaves unclear which services are covered. It also allows managed care plans to make unreasonable charges for cost sharing, thus gutting the intent of the prudent layperson standard. In addition, it adds another layer of ERISA plan bureaucracy."

In his letter to the Subcommittee, Dr. Moorhead said:

"ACEP strongly supports inclusion of provisions that would require health maintenance organizations to cover emergency services for beneficiaries based upon the 'prudent layperson' standard, consistent with the definition of 'emergency medical condition' contained in the Emergency Medical Treatment and Labor Act. This prudent layperson standard is also included in H.R. 904, and ACEP hopes the Roukema-Cardin prudent layperson language will be included in the mark at the full Committee.

"Unfortunately, [H.R. 2045] substantially narrows the 'prudent layperson' standard so that patients would only be covered for an initial, but undefined, 'appropriate screening examination.' For all other services, including potentially life-saving treatments, emergency physicians would have to certify in writing that the patient needed immediate emergency medical care. Yet the plan would only be required to cover such care if a 'prudent emergency medical professional' would agree with the treating physician's judgement. [These additional bureaucratic processes have the potential to delay timely emergency care.] Therefore, this legislation would establish new loopholes for the managed care industry to second-guess patients and emergency physicians about the delivery of emergency services. Patients, who in severe pain make a reasonable decision to seek emergency care, would not be fully protected. "ACEP urges you to support the language in H.R. 904, the 'Access to Emergency Services Act of 1999' to preserve and promote access to quality emergency 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.