Wisconsin Commissioner of Insurance Mark V. Afable released a
bulletin to health plan issuers on Sept. 22 requesting that health plan issuers work with health care facilities facing capacity issues to remove any barriers to transferring patients to other facilities for their post-acute care.
Commissioner Afable wrote, “The recent surge in cases related to the Delta variant of COVID-19 is placing a strain on the capacity of hospitals and other healthcare facilities equipped to treat patients with COVID-19. In addition, workforce shortages and capacity issues are leading to a shortage of the availability of post-acute care facilities, such as nursing home and skilled-nursing facilities. As a result, patients that no longer need acute care are being housed at hospitals when they would normally be discharged to a post-acute care facility. This is placing further strain on capacity issues as it limits the amount of beds and staff available to treat COVID-19 and other conditions requiring acute care.”
The Office of the Commissioner of Insurance (OCI) is strongly encouraging health plan issuers to remove or streamline any prior authorization requirements and to consider coverage for out-of-network facilities where in-network facilities are unavailable. OCI also requests that insurers consider providing coverage for swing bed programs, both within the initial hospital’s facility and by allowing a hospital to utilize unused patient capacity at other hospitals.
The OCI bulletin comes as hospitals manage inpatient capacity issues related to the ongoing pandemic. Hospitals in some regions of the state have reported up to 20% of their inpatient capacity used by patients ready for discharge but needing post-acute care and without a nursing home that will accept them, including for insurance-related reasons. WHA has been in discussions with the Wisconsin Department of Health Services and OCI about actions that can be taken to support hospitals and their patients during this critical time. WHA encourages its members to share the bulletin with the health plans frequently covering their patients.
The
bulletin includes additional details related to the request.