Many emergency conditions can be difficult to discriminate for a prudent lay person, and emergency physicians evaluate and stabilize all patients who present to the ED.  A strong network of health care includes both a robust primary care system and emergency services, which involves more coordination of care.  It does not include denying payment for care for potentially emergent complaints that then turn out to have non emergent causes.  The reality of our current system is that many PCPs refer patients to the ED for acute care, and our most marginalized will be hurt if emergency departments are limited by reduced payments.  The prudent layperson standard is necessary to ensure equal access to timely care.  Please recognize the harm that changing this standard will cause to both EDs and patients and reiterate that states must honor the prudent layperson standard.