March 29, 2024 reminder: This temporary waiver will end on April 1, 2024.
To: Skilled nursing facilities and rehabilitation hospitals caring for our members
As we did in early 2023, we will again temporarily waive authorization requirements for patient transfers from acute care hospitals to help skilled nursing facilities (SNFs) and acute rehabilitation hospitals manage an influx of inpatient admission requests. This relaxation of authorization requirements will last from January 8, 2024 through April 1, 2024.
The authorization waiver does apply to:
The authorization waiver does not apply to:
Skilled nursing and acute rehabilitation facilities are required to notify us of any admissions within 24 hours of admission. We will approve the first five days and, thereafter, clinical documentation will be required to support continued skilled level of care at the facilities.
Type of review |
Requirement for commercial HMO and PPO, Medicare Advantage, Indemnity |
Requirement for Federal Employee Program |
---|---|---|
Initial admission |
Notification only |
Medical necessity |
Concurrent |
Medical necessity |
Medical necessity |
Definitions
Notification only required |
Does not require submission of clinical documentation for initial admission |
Medical necessity review required |
Requires that the requesting provider submit clinical documentation in support of the request |
How to notify us
MPC_120722-1Z-1-ART