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September 25, 1998     Cape Gazette
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September 25, 1998

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CAPE GAZETTE, Friday, September 25 - October I, 1998 - 43 Castle supports act to increase access to emergency rooms Delaware congressman Mike Castle recently held a PreSs con- ference with Delaware emergency physicians at Christiana Hospital to show his support for the Access to Emergency Medical Services Act - H.R. 815. The legislation would establish a national prudent layperson stan- dard for emergency care and pre- vent health insurance plans from requiring preauthorization as a condition to obtaining reim- bursable emergency care services. "In emergency situations, every minute, and sometimes, every sec- ond counts. No person should ever have to worry during those sec- onds about whether or not their in- surance company will pay for emergency treatment," Castle said. "The Access to Emergency Ser- vices Act will protect patients and allow doc- tors and hospi- tals to provide necessary treatment to patients; re- gardless of health-plan af- filiation, and CASTLE still be reimbursed for their ser- vices," he said. The Access to Medical2Services Act is supported by the American Medical Association and the American College of Emergency Physicians. Specifically, H.R. 815 would accomplish the following: Establish a national prudent layperson standard for emergency medical treatment that would ap- ply to all health insurance 'plans that cover emergency care, includ- ing those that are self-insured and Medicare/Medicaid programs; Require such plans to cover emergency treatment, even in out- of-network facilities, for individu- als who, possessing average knowledge of health and medi- cine, could reasonably assume their symptofns might cause seri- ous impairment to health and bod- ily functions or organ dysfunction. This would preclude plans from paying benefits based on a final diagnosis rather than a patient's symptoms; Prohibit plans from requiring plan preauthorization as a condi- tion for coverage before obtaining emergency care; Limit cost sharing, in particu- lar, when patiems using the pru- dent layperson Standa/xl or in cir- cumstances beyond their control are treated at a nonparticipating emergency provider or physician. In other cases, plans are allowed to impose only reasonable cost- sharing differentials; Provide a process for coordi- nating post-stabilization care in which treating physicians and health plans would be required to communicate in a timely manner on medically necessary post-stabi- lization care, identified as part of a federally required screening ex- amination. Plans, in coordination with the treating physician, would be permitted to arrange an alterna- tive treatment plan to assume care of the patient; Would not pre-empt state law unless it prevents application of the federal law; Require that plans educate their members regarding emer- gency care coverage and appropri- ate use of emergency medical ser- vices. The bipartisan bill, introduced by Rep. Ben Cardin, D-Md., and Rep. Marge Roukema, R-N.J., currently has 241 co-sponsors.