Medicare Authorization Flexibilities to be implemented January 11, 2022 through January 31, 2022
Inpatient Admissions: We will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.
Post-Acute Accommodations for rehab hospitals and Long-Term Acute Care hospitals (LTACH): We will relax our requirements related to facility transfers including:
- We will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities.
- We will not require sending facilities to provide notification of transfer to participating providers.
- However, we will require receiving facilities to notify the health plan of patient admission. And we will accept notification up to five days post-transfer.
- We will continue to conduct medical necessity review
- Because we will not have visibility prior to transfer, we request that hospitals utilize our in network post-acute facilities
Skilled Nursing Facilities: We will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.
