American Academy of Emergency Medicine

Position Statement on the Proposed Cardin Bill

The American Academy of Emergency Medicine (AAEM) supports the proposed H.R. 2011 (the Cardin Bill) and rejects the modifications to the Bill suggested by an agreement between select leaders of the American College of Emergency Physicians (ACEP) and Kaiser-Permanente.

AAEM's position is based on the following:

  1. The proposed Cardin Bill recognizes the "gap" in current Federal Law which mandates Emergency Department evaluation of all patients presenting for care, yet does not require insurers’ payment for these services.
  2. The Cardin Bill would close this statutory "gap" by requiring insurers, including Managed Care Organizations (MCOs) to pay a reasonable fee to Emergency Department providers for Emergency Medical Services rendered on behalf of their enrollees.
  3. The ACEP/Kaiser proposal impairs the remedial effect of the Cardin Bill in the following ways:
  1. Sections 4A and 4B of the ACEP/Kaiser agreement create unacceptable exceptions to the prudent lay person test. These exceptions would allow an MCO to deny coverage for an Emergency Department visit to a non-contract hospital unless the visit was necessitated by "…circumstances beyond (the patient’s) control."
  2. The ACEP/Kaiser proposal appears to be more restrictive than the Cardin Bill in regards to post-stabilization treatment of patients. The ACEP/Kaiser proposal requires the emergency physician to seek prior authorization from the MCO for any care beyond the initial stabilization. The uncertain line between "stabilizing" care and "post-stabilizing" care will be a problem for health care providers and patients alike. This issue of post-stabilization care opens the door for transferring patients that are not completely stabilized from the ED of one institution to the MCO’s own institution. This would be done for economic reasons only and has the potential to endanger patient safety and well-being.
  3. The ACEP/Kaiser proposal resolves disagreement between the treating emergency physician and the MCO in favor of the MCO. AAEM believes the statute should give greater consideration to the preferences and needs of the patient in settling disagreements between practitioners and MCOs.
  1. AAEM applauds Representative Cardin and his cosponsors of the statute "to assure equitable coverage and treatment of emergency services under health plans." AAEM agrees with the stated findings and purpose expressed in the Cardin Bill. Fairness demands the Federal Government now mandate insurers’ payment for EMTALA-mandated Emergency Department evaluations and treatments. A statute clearly establishing this duty will direct insurers’ resources away from chart reviews used to retrospectively deny coverage for Emergency Department services. Insurers’ incentive to decrease Emergency Department expenditures could be satisfied by educating their enrollees and providing appropriate and timely alternatives.

Adopted by the AAEM Board of Directors, November 13, 1996.