Dear DMAS:

Patients should never be put in a position where they are expected to self-diagnose and determine whether an emergency condition exists before being seen by a medical professional.  As you know, this is called the "prudent layperson" standard and it requires care to be provided if the patient believes they are having an emergency.  We believe that CMS guidance obligates state Medicaid programs and managed care organizations to reimburse doctors and hospitals for the delivery of such emergency medical care based on presenting symptoms, not using a diagnosis list.

While Medicaid patients will continue to receive care and will never be billed for the difference if the visit is determined to be non-emergent, patients will be impacted for multiple reasons:

1) Dramatically reduced payments will result in fewer physicians in the ER and much longer wait times, specifically in urban and rural hospitals, which have a higher percentage of Medicaid patients.

2) The financial viability of the Emergency Departments and their hospitals is already threatened due to losses from COVID-19 where, during lock-downs, volumes declined as much as 40% due to both a lack of vehicle traffic and patients' fear of catching the virus. This resulted in delayed care and missed opportunities to treat strokes and non-fatal heart attacks, both of which leave unnecessary permanent damage to the patient.

3)Underrepresented minorities have always lacked access to healthcare and suffered the worst outcomes in the U.S. The problem was made worse in the COVID-19 pandemic.  As you know, African-Americans are THREE times more likely to contract COVID-19 and SIX times more likely to die from it than any other racial group.  This is occurring primarily because minorities in the U.S. have higher rats of co-morbidities that increase risk factors for COVID-19 (obesity, lung disease, diabetes, high blood pressure, and other immune-compromising diseases).  Many of those conditions are on the "preventable"diagnosis list.

We ask that DMAS temporarily halt implementation July 1st to comply with the prudent layperson standard and ensure equal access to healthcare for all Virginians.

Thank you for your consideration.