On March 1, 2012, NH Medicaid implemented a policy that imposed a 4-visit service limit on Medicaid recipients' visits to hospital emergency Departments. After analyzing that policy, NH Medicaid determined that it did not have the desired effect of redirecting patients to more appropriate sites for care. Therefore, NH Medicaid is removing this limit retroactively back to its effective date of March 1, 2012.
NH Medicaid recipients will receive notice of the change by the end of July. This will notify Medicaid recipients of the service limit change and that they may be entitled to receive reimbursement from a hospital if they made payments for an Emergency Department visit that was denied for being in excess of the 4-visit limit. A copy of the notice sent recipients will be available to you in the message center when it is mailed to the recipients.
To facilitate a smooth process for timely payments, NH Medicaid will issue specific instructions to the hospitals on July 29, 2013, for the submission of ED claims for this period. In addition to issuing instructions, Medicaid and The Health Enterprise Medicaid Management Information System (MMIS) will work with each hospital individually to process their claims submissions.
We look forward to working with you to continue to find ways to ensure that Medicaid enrollee's receive the best possible care in the most appropriate and cost effective settings.