Resolution 19(10) Emergency Care at Non-VA Facilities for US Veterans
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Resolution 19(10) Emergency Care at Non-VA Facilities for US Veterans
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RESOLUTION: 19(10)
SUBMITTED BY: Connecticut Chapter
SUBJECT: Emergency Care at Non-VA Facilities for United States Veterans
PURPOSE: Work with the VA to improve veterans’ access to emergency care through adoption of the Patient’s Bill of Rights and prudent layperson standards and reduce restrictions on post stabilization care.
Resolution 19(10) Emergency Care at Non-VA Facilities for US Veterans
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WHEREAS, Recent healthcare reform adopted a patient’s bill of right and prudent layperson standard to be applied to all health care plans; and
WHEREAS, Many veterans are insured solely by VA – Health Care; and
WHEREAS, VA – Health Care requires a Veterans Affairs (VA) clinician to determine that a VA facility or other federal facility was not feasibly available, and an attempt to use them beforehand would not have been reasonable, sound, wise, or practical before paying for the emergency department visit; and
WHEREAS, Some VA patients require admission to inpatient units; and
WHEREAS, VA requires emergency physician to transfer patients based on the insurance to a VA hospital often very far from family and community if beds are available or the admission to the non-VA hospital will be denied; and
WHEREAS, The VA Website states, “VA will pay for your emergency care services only until your condition is stabilized. If you stay beyond that point, you will assume responsibility for the payment of costs associated with treatment.”; therefore be it
RESOLVED, That ACEP meet with the Veterans Administration and encourage their adoption of the Patient’s Bill of Rights and prudent layperson standard; and be it further
RESOLVED, That ACEP encourages the Veterans Administration to stop the practice of retrospective analysis of emergency department visits to determine which claims to pay; and be it further
RESOLVED, That ACEP endorses, supports, and advocates during the meeting with the Veteran Administration to allow VA Health Care beneficiaries to be admitted to non-Veterans’ Administration hospitals and reimburses health care costs for provided care.
Resolution 19(10) Emergency Care at Non-VA Facilities for US Veterans
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Background
This resolution calls for the College to request the Veterans Administration (VA) to adopt the prudent layperson standard and the Patient’s Bill of Rights as standards for the VA health care system and stop retroactive review and denials of payment for emergency services to veterans.
“The Veterans Mental Health and Other Care Improvements Act “of 2008 (P.L. 110-387) created authority for the VA to pay for emergency services rendered to veterans with both service-connected and non-service connected disabilities at non-VA hospital emergency departments. Need for emergency services is determined using the prudent lay person standard.
Draft regulations were released by the VA on June 11, 2010, amending the previous regulatory language that stated that the VA “may” pay for emergency services rendered in non-VA facilities. In addition to changing the language to “shall” pay, the VA will also pay for post stabilization care at a non-VA facility if documented efforts are made to transfer the stabilized patient to a VA hospital or other federal facility with which the VA has ties, and the recipient facility cannot (or will not) accept the transfer. If the patient refuses the transfer, the VA will not be liable for additional costs of post stabilization care. As to what the actual reimbursement amount will be, the draft regulation refers to the statutory language of the provider’s “usual and customary charges” and notes that a methodology for determining payment will be addressed in a subsequent rule.
On February 1, 2010, Congress passed “The Veterans’ Emergency Care Fairness Act “(P.L.111-137).
This new law directs the VA to reimburse uninsured veterans for emergency services in non-VA hospitals. It will cover any difference between a third party insurer and the maximum charge permitted (not including co-pays). The law includes services prior to the date of enactment, giving the Secretary of the VA discretion to determine a cut-off date for retroactive reimbursement. CBO estimated that retroactive payment would not reach back before 2005.
Between these two recent laws, it appears that coverage and payment for emergency services at non-VA hospitals has been addressed. ACEP staff can track the status of release of a final rule and set up a mechanism for members to report continuing problems. If needed, meetings between the College and the VA can be initiated to resolve any outstanding problems with implementation of the new laws.
ACEP Strategic Plan Reference
Goal 3: Ensuring Fair Reimbursement
Fiscal Impact
Budgeted staff time to collect anecdotal information from ACEP members on continued coverage and payment problems experienced by veterans seeking emergency care. If necessary, write a letter to the VA, outlining our concerns and requesting a meeting. The meeting may be more effective with an ACEP member(s) who has reported problems. Travel costs for in-person meeting: $850 per person (airfare average $450, hotel $200 per night, and $200 per diem).
Prior Council Action
Resolution 20(07) Payment for Discharged and Admitted ED Patients Whose Insurance is not Accepted by the Emergency Physician Group and/or Hospital defeated. The purpose of the resolution was for ACEP to appoint a task force to study transfers of ED patients for insurance reasons and to develop a policy prohibiting transfer of ED patients solely for insurance reasons.
Prior Board Action
None
Background Information Prepared By: Barbara Tomar, Federal Affairs Director
Reviewed By: Arlo F. Weltge, MD, FACEP, Speaker
Marco Coppola, DO, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director