Not wanting anyone to overwhelm hospitals during this peak season of respiratory illness, state officials have negotiated a waiver that allows patients to step down to a skilled nursing facility before they can guarantee payment from insurance companies.
The waiver will only apply to around 484,000 Connecticut residents with fully-insured insurance plans regulated by the state.
“During this critical period, we must have the ability to discharge patients who no longer require an inpatient hospital bed in a timely manner. This will open beds for patients who require more intensive inpatient care,” Insurance Department Commissioner Andrew Mais said Monday. “We understand how important appropriate prior authorization is as a tool to manage rising healthcare costs in our state, that’s why this is a temporary request to better manage the projected surge.”
The waiver, according to Public Health Commissioner Manisha Juthani, will expedite the discharge of patients that are ready for an alternative level of care.
“Starting with RSV and now with rising cases of flu and COVID, our hospitals are experiencing the anticipated surge of patients with respiratory viral diseases this season. The strain on the healthcare system is the backdrop of staffing shortages that our hospitals have already been experiencing,” Juthani said.
There have been more than 6,000 influenza cases in Connecticut and one death this year. And as of today there were 460 Connecticut residents hospitalized with COVID-19. Connecticut also has hundreds of RSV cases and many of those hospitalized with the illness are children.
Department of Social Services Commissioner Deidre Gifford said it’s important to minimize administrative delays.
“We appreciate the collaborative approach that hospitals and insurers are taking to make sure patients can be appropriately cared for at the right level of care,” Gifford said.
The Connecticut Association of Health plans and their membership, Aetna/CVS Health, Anthem, CIGNA, ConnectiCare, and United were all instrumental in expediting this change to address the potential health care crisis. “Their effort during this extraordinary time is truly appreciated,” said Mais.
The health insurance carriers have committed to this waiver for all fully-insured plans and for Medicare, Medicare Advantage, and Medicaid plans on a temporary basis. Depending on the carrier it could last anywhere between 60 to 90 days.
However, it does not include all health insurance plans. Self-insured plans or employer sponsored plans are not covered by the waiver because they are not regulated by the state.