Legislation that would have impacted payment made by HMOs to
providers of emergency care has been considered by the
Legislature for the past several years. The current law provides
that non-contract providers of emergency services to HMO
patients are to be paid the lesser of: 1) the provider’s
charges; 2) the usual and customary provider charges for similar
services in the community; or 3) a mutually agreed upon charge.
The HMO industry has sought to add a fourth prong to this
payment determination, essentially limiting payment to a certain
percentage of the Medicare rate (i.e. 125%). FCEP members Drs.
Meadows, Leonhardt, Siegel, Bradley, and others have been
particularly involved during the past two years in educating
certain key legislators and representatives of the HMO industry
about the impact of such payment limitations on emergency
physicians. Legislation was filed this session in the Senate,
and was expected to be considered in the House, to limit payment
for non-contract emergency care providers to 120% of the
Medicare rate. FCEP and other concerned physician organizations
were provided assurances that physicians would be held harmless
in this legislation. While physicians were indeed not included
in the legislation, concern was raised regarding the overall
impact of such reductions relative to hospitals’ ability to
provide consistent access to a quality emergency care system
throughout Florida. The legislation was not passed by the 2004
Legislature.
