Some main medical insurance suppliers in Massachusetts have agreed to waive prior authorizations on choose hospital transfers after Gov. Maura Healey’s administration this week warned of “severe capacity challenges,” in response to a doc obtained by the Herald.
In a memorandum to prime well being officers dated Jan. 9, Health and Human Services Secretary Kate Walsh additionally stated hospitals within the state have agreed “to commence discharge planning and care coordination as early as practicable” for sufferers as they face file occupancy ranges, “significant” workforce shortages, and the circulation of three totally different viruses.
“These issues exist across the system and require immediate, short-term action on all parts to release pressure in the system and support timely patient transitions to the most appropriate care setting,” Walsh wrote within the memorandum. “To that end, we have requested, and your respective membership organizations have expressed support for, the following temporary operational and practice flexibilities to mitigate the impacts of this significant surge.”
As a part of the plan, Walsh stated Blue Cross Blue Shield of Massachusetts and Massachusetts Association of Health Plans members agreed to voluntarily waive prior authorization beginning Jan. 9 by means of April 1 for admissions from acute care hospitals to sub-acute care and rehabilitation services “across commercial, Medicaid, Medicare, and Medicare Advantage lines of business.”
The waiver doesn’t apply to long-term or custodial admissions and well being plans can conduct “retrospective and concurrent” critiques throughout the time-frame “to determine appropriateness of level of care,” the memorandum stated.
“Acute care hospitals and post-acute care facilities will be expected to notify plans about any inpatient admission for which post-acute care is anticipated within 24 hours of admission and to provide updates, at a minimum of every five days, to support discharge planning,” Walsh wrote.
Massachusetts Blue Cross Blue Shield CEO Sarah Iselin stated native hospitals are experiencing extreme capability challenges together with excessive ranges of respiratory sickness and workforce shortages.
“By removing prior authorization requirements for admissions from acute care hospitals to sub-acute care facilities and rehabilitation facilities, we hope to help hospitals ensure as many people as possible get the care they need,” Iselin stated in a press release to the Herald.
A spokesperson for the Executive Office of Health and Human Services stated the administration applied the measures to “ensure people are getting the care they need while reducing strain on the healthcare workforce.”
“We encourage everyone to get vaccinated against respiratory viruses like RSV, COVID and flu in order to reduce the severity of illness,” the spokesperson stated in a press release to the Herald.
The measures outlined within the memorandum from Walsh had been additionally put in place final winter and are sometimes activated when there is a rise in respiratory diseases impacting hospital capability, in response to the Executive Office of Health and Human Services.
The Massachusetts Department of Public Health reported Thursday that the influenza severity degree was “high,” COVID-19 emergency division visits had been “moderate,” and COVID-19 hospital admissions had been “medium.”
Just over 17% of emergency division visits over the past week had been for acute respiratory illness, in response to the Department of Public Health. Officials reported 19% of Massachusetts is vaccinated towards COVID-19 and 38% towards influenza as of Jan. 6.
COVID-19 wastewater ranges have additionally spiked within the Boston-area.
Massachusetts Health and Hospital Association President and CEO Steve Walsh stated the settlement to waive prior authorizations for some transfers was “voluntary.”
“The easing of prior authorization requirements can be an especially powerful tool for hospitals to keep patients moving along their care journey,” Walsh stated in a press release.
Some sufferers in hospital beds are able to be discharged to rehabilitation settings however well being plans could require a “prior authorization” process earlier than agreeing to cowl the rehab keep. That authorization might delay a transfer for hours or days, in response to the Healey administration.
Insurers’ settlement to droop the prior authorization necessities permit sufferers to be discharged to rehab services extra rapidly, in flip liberating up inpatient beds for different folks, in response to the Executive Office of Health and Human Services.
But nonetheless, Walsh struck a dire observe on staffing shortages.
“Hospitals must also seek innovative ways to improve their staffing plans with a goal to fully staff all licensed adult medical/surgical beds,” Walsh wrote within the memorandum.
Source: www.bostonherald.com”