This amendment directs the Department of Medical Assistance Services to allow the pending, reviewing and reducing of fees for avoidable emergency room level two, three and four claims, both physician and facility. The department would utilize the avoidable emergency room diagnosis code list currently used for Managed Care Organization clinical efficiency rate adjustments. If the emergency room claim is identified as a preventable emergency room diagnosis, the department shall direct the Managed Care Organizations to default to a payment level one. The amendment captures savings to the Medicaid program from the implementation of this policy.