NJ bill caps Medicaid payments at $140 for nonemergent ER visits

The New Jersey legislature passed a bill June 21 that would limit how much the state's Medicaid program pays hospitals for treating low-acuity beneficiaries in the emergency room, according to nj.com.

The bill, introduced and approved in committee June 18, would cap payments for N.J. FamilyCare members at $140 for nonemergent use of a hospital's ER. On average, treating low-acuity Medicaid beneficiaries in the ER costs $600, according to Wardell Sanders, president of the New Jersey Association of Health Plans.

According to the bill, the New Jersey Department of Human Services would determine what visits are low acuity.

In a statement to nj.com, Mr. Sanders said, "New Jersey needs to move away from a payment model that gives financial incentives to deliver primary care in the most expensive care setting."

However, hospitals largely disagree with the bill. Neil Eicher, vice president of government relations and policy at the New Jersey Hospital Association, told the publication, "Hospitals should not be penalized for doing the right thing by providing quality care to patients who show up at our doors because insurance companies have failed to provide a network of providers available to these patients."

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