Online CPR Certification Blog

The new Medicaid programs have caused a crisis in various medical institutions, who are trying to balance the application of the programs and service provision. Budget crisis caused by the programs has given the directors a reason to alter their service provision standards to cut costs and reduce risks that come about because of the government’s failure to pay for the services rendered. The alteration is a risk to the health of the patients because. To be on the safe side financially, some states are using the past definition to determine what a severe case of medical emergency is, so that they can have the basis of claiming the payment from the government.

Fight for Favorable Regulations

The old definition directs that an emergency medical condition is when there are serious symptoms that attack a patient in form of severe pains that if not attended to may jeopardize his or her life or alter the functionality of the body permanently.

Before 1997, a number health insurance companies and managed healthcare providers decided to narrow down the factors that could determine the medical cases that were to be funded by Medicaid. This decision was focused mainly on State Primary Care Case Management Programs and Medicaid Managed plans. The reduction of the cases could cushion the insurers and help them minimize risks. They also needed to be called prior to attending to the insured patients.

The Ultimate Solution

The policies were later neutralized in 1997 by the Balanced Budget Act, which provided increased protection to patients. The authorization call, for instance, was scrapped off, and a change in the regulations gave patients an excusal in the case of distinguishing serious illness from mild medical problems. The reasoning was that prevention is better than cure because, the insurer would pay less for a prevention medical procedure, than what it would cost them to treat a serious medical problem like stroke or cardiac arrest. This will save many lives because if enrollees only have to be treated when seriously sick, and then there will be cases that cannot be arrested when they get to medical facilities, but could have been prevented earlier.

Those who have enrolled to the managed care program will be the main beneficiaries, because the enrollees of the Medicaid fee-for-service program will be dependent on the government to clear the bills, a thing that medical organizations are not comfortable with. A number of states have agreed to include the prudent layperson standard to the medical programs, but 21 states are still adamant to take the tow and instead are applying more restrictions on the insurance of emergency care. The lists for emergency diagnoses that are approved by these states are worrying because the medical cases listed are very severe that before a patient gets to the hospital it might be very late.