April 27, 2021
On April 2, 2021, Commissioner Anderson released Bulletin 2021-03, supplementing and superseding Bulletins 2020-10 (Credentialing and Prior Authorization during COVID-19) and Bulletin 2020-13 (Coverage for COVID-19 Treatment and Out-of-Network Emergency and Inpatient Reimbursement During the COVID-19 Health Crises).
The bulletin reminds carriers that they are expected to provide coverage and forgo any cost sharing for medically necessary outpatient COVID-19 treatment and rehabilitation services delivered by in-network providers. When the services are provided in an emergency department, there also should not be any cost sharing whether in-network or out-of-network. Additionally, all in-network providers must be reimbursed at that contractually allowed amounts.
The Division also expects carriers to suspend any prior authorization requirements and to provide inpatient hospitals with up-to-date lists of in-network rehabilitation hospitals and skilled nursing facilities. The bulletin also explains how carriers are expected to reimburse out-of-network acute care hospitals and the out-of-network providers providing emergency department and inpatient services.
Although this guidance affects insurance carriers, employers should familiarize themselves with this guidance.
Bulletin 2021-03 »