New Bulletin on Coverage/Reimbursement for Emergency Room Boarding

On July 25, 2019, the Insurance Department published Bulletin Docket No. INS No. 19-106-AB. The new bulletin relates to SB 11, a new law enacted in 2019 (which takes effect July 1 2019), which requires certain coverage and reimbursement for emergency room boarding. The law and bulletin expands required coverage and provider reimbursements for individuals who are in an acute care hospital, awaiting admission on a voluntary basis for services to treat a mental health condition as a result of mental illness, or when the individual is waiting to be admitted to a NH hospital (or community-based designed receiving facility to treat a mental health condition), the hospital has completed an involuntary admission certificate that meets certain criteria.

The law and bulletin require carriers to pay the acute care hospital a per diem rate required to board and care for the patient. The law prohibits the per diem rate from being all inclusive, and the bulletin interprets the law to mean that a hospital may bill for services not included in the per diem rate and that the hospital shall receive payment for these additional services insofar as they are medically necessary from the perspective of the treating provider. The per diem rate is distinct from inpatient reimbursement, and the per diem rate for the hospital stay may include member cost sharing liabilities consistent with the IRS requirements for HDHPs. The bulletin also includes additional guidance on provider reimbursement rates and consecutive days of coverage.

The bulletin contains no new employer compliance obligations. But employers with fully insured plans in NH should be aware of the coverage requirements under the new law and bulletin.

Bulletin Docket No. INS. No. 19-016-AB »
SB 11 »