COVID-19 UPDATE: Governor Sununu’s Emergency Order 30 Addresses Delivery of Healthcare Services in Alternative Sites

On April 9, 2020, Governor Sununu issued Emergency Order 30. It sets out rules and recommendations to ensure that healthcare services provided in “alternative care sites” (ACS) are equitably billed and paid for by insurers.

1. The order first notes that hospitals are implementing emergency preparedness plans to treat patients in a variety of ACSs, including schools, auditoriums, convention centers, and other subsidiary facilities like rehab hospitals and nursing homes.
2. The Order ensures that any medically necessary services provided in an ACS will be treated and billed at in-network rates by all regulated health insurance. If a treating provider is out-of-network, reimbursement must be made at the transferring or diverting provider’s in-network rate. And providers who are out-of-network and reimbursed as in-network under the Order are not permitted to balance bill the member.
3. In addition, acute care services that are delivered at ACSs must continue to be coded and reimbursed as acute care regardless of the non-traditional setting. Transfers of patients for non-acute care services to a lower level of care setting, typical during a regular course of treatment, are not subject to the terms of the Order.
4. Because many non-COVID acute care patients are likely to be transferred or diverted to ACSs or other hospitals, the Order applies whether or not the patient is being treated for COVID-19.
5. Carriers must ensure that rates of payment for ACS-related treatment are not lower than rates applicable to care delivered in more traditional settings. Carriers must also notify providers of any information or instructions needed for them to bill properly for ACS services.
6. The Order took effect on April 9th, 2020 and remains in effect until rescinded, or until the State of Emergency is terminated, whichever happens first.
7. The Order directs the Department of Health and Human Services and the Insurance Department to provide necessary assistance and guidance in the interpretation of the Order and empowers the Insurance Department to enforce the Order as it applies to health insurance carriers.

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