In 1986, Congress passed the Emergency Medical Treatment and Labor Act (EMTALA) to protect patients’ access to emergency medical care, regardless of their ability to pay. More than a decade later, the federal Prudent Layperson (PLP) Standard came about as a product of the Balanced Budget Act of 1997, and it was applicable to Medicare and Medicaid health plans. Through the passage of the Affordable Care Act in 2010 and other regulatory initiatives, the PLP Standard expanded to 48 states and to government and commercial health insurance plans.

The PLP Standard was created to protect patients’ rights to access emergency medical care without prior authorization by their primary care clinician, and to ensure that clinicians are reimbursed for treating patients under the PLP Standard. However, in recent years, PLP has been threatened by specific Medicaid and commercial carriers trying to undermine clinicians' reimbursement.  

Many states are trying to control their budgets by restricting patients who otherwise do not have adequate access to healthcare from accessing emergency medical care when federal EMTALA and PLP Standards guarantee both access (EMTALA), coverage, and payment (PLP). These restrictions threaten patients’ lives and punish the clinicians who are obligated to treat all patients who seek emergency care.  

Listen to our podcast, Zotec Answers, to hear Ed Gaines, JD, CCP dive further into this topic.