The New York State Department of Financial Services (DFS) on Dec. 13 issued a letter directing insurers to suspend certain preauthorization and administrative requirements to help hospitals implement New York’s “surge and flex” protocol. The protocol — which mandates all hospitals to begin expanding their bed capacity to prepare for a COVID-19 surge — is part of […]
The New York State Department of Financial Services (DFS) on Dec. 13 issued a letter directing insurers to suspend certain preauthorization and administrative requirements to help hospitals implement New York’s “surge and flex” protocol.
The protocol — which mandates all hospitals to begin expanding their bed capacity to prepare for a COVID-19 surge — is part of the winter COVID-19 plan that Gov. Andrew Cuomo recently announced, per the DFS website.
The DFS letter was “developed in collaboration with the insurance industry and hospitals,” the department added.
With the action, hospitals will be ready to “quickly” transfer patients between hospitals and, “when appropriate,” discharge patients to skilled-nursing facilities or their homes to increase bed capacity and balance patient load.
Similar regulatory relief was granted in March during the first COVID-19 surge in the state, the DFS noted.
“After what we saw in the spring, we know that preventing hospitals from becoming overwhelmed needs to remain a top priority moving forward. …This new guidance will help streamline hospitals’ ability to quickly transfer patients between facilities, increase bed capacity and balance patient load,” Cuomo said.
The letter directs insurers to suspend certain requirements for 60 days. They include preauthorization review for urgent or non-elective scheduled inpatient surgeries, hospital admissions and transfers between hospitals; for inpatient rehabilitation and home health-care services following an inpatient hospital admission; and for inpatient mental-health services following an inpatient hospital admission.
“A temporary suspension of preauthorization and other administrative requirements provides necessary flexibility for hospitals during this critical time to maintain sufficient hospital bed capacity,” Linda Lacewell, DFS superintendent, said. “We encourage insurance companies and hospitals to continue to work together to ensure that COVID-19 patients receive the care they need.”
The state reminds insurers that they are prohibited from denying emergency department and inpatient hospital treatment provided during the declared state of emergency for diagnosed or suspected COVID-19 cases “as not medically necessary on retrospective review.” In addition, hospitals should use their best efforts to continue to provide insurers with notifications, including information necessary for the insurer to assist in coordinating care and discharge planning of emergency hospital admissions.
