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Judge Backs AHCA on Immigrant ER Care

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AP
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An administrative law judge Monday ruled in favor of the state Agency for Health Care Administration in a long-running dispute with hospitals about emergency care for undocumented immigrants.

The case focused on Medicaid payments that hospitals receive when undocumented immigrants go to emergency rooms.

Judge John D.C. Newton, in a 43-page decision, rejected arguments by a coalition of hospitals that the Agency for Health Care Administration had overstepped its authority in approving rules that involve the duration of payments.

"The agency was resolute in its commitment to only apply the standards and definitions of statutes and rules in the evaluation of claims for payment for emergency medical services to undocumented aliens,'' Newton wrote.

In 2012, Newton ruled against AHCA in an earlier case brought by hospitals. That case stemmed from a change that AHCA made in 2010 to allow payments until patients were "stabilized." The hospitals argued the change was made improperly and that it led to claims being denied and to attempts to recoup money from hospitals.

After that case, AHCA discontinued its use of what Newton described as the "stabilization standard" and changed the process for evaluating claims.