Update on Medicaid Low-Acuity ED Fee Changes

  • 2 November 2018
  • Author: Lauren Myers
  • Number of views: 2479

In response to provider concerns, DHS removed all of the Mental Health and Behavioral Health codes from the list. There are age exclusions, as well.  DHS also considered our suggestion to exempt any non-emergent ED visits that occurred after hours or on the weekends, but given the significant changes DHS had already agreed to, Department officials did not include those exemptions. The 1,200 codes should be available shortly on Molina's website and once "live," Molina will reprocess any necessary claims without any action needed by the hospital.

The Department of Human Services still plans to promulgate regulations which will also include a public comment period. However, the legislation mandated that the policy will go into effect on November 1 even if the regulations have not yet been adopted.

There is significant interest on the Medicaid managed care plans to implement a similar reimbursement policy for facilities AND professional fees. So, our work here has been very important in anticipation of this potential effort by MCOs.

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