Payers Relax Hospital Transfer Policies, Match Medicare Waivers

America’s Health Insurance Plans (AHIP) committed to supporting provider partners, specifically hospitals and health systems, as they combat coronavirus.

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“We know that our essential partners—doctors, nurses, hospitals, post-acute providers, labs and other health care professionals—are under enormous pressure and stress,” AHIP acknowledged in a statement from the board of directors. “In particular, inpatient hospitals are on the brink of becoming overwhelmed as they care for our out vulnerable patients, while simultaneously facing scarcity of supplies shortages of staff, and higher risks for infection for their workers.”

In response to these challenges and needs, AHIP’s commitment was twofold.

The payer organization committed to following Medicare’s lead in matching waivers and relaxing its policies in hard-hit areas.

In addition to the Medicaid waivers for which CMS released a number of templates in the past week, the agency has also been focused on getting care to Medicare beneficiaries who are at high risk for contracting and potentially dying from coronavirus.

CMS made coronavirus testing free for Medicare beneficiaries in early March and, through the Families First Coronavirus Response Act, eliminated any cost-sharing for the visit to the provider to get tested. CMS has also expanded telehealth options for Medicare beneficiaries.

AHIP’s board stated that it would follow these decisions and also relax policies in areas where the hospitals are overwhelmed by the volume of coronavirus patients in order to improve hospitals’ resources.

“These actions will speed patient care to safe and available settings so that providers can more effectively manage an increasingly complex environment. They will help expand hospital capacity for COVID-19 patients so that we can leverage every available care resource. And they will help patients get the care they need when they need it,” the payer organization stated.

Additionally, AHIP expressed its commitment to expanding capacity at overwhelmed hospitals. This includes assistance in transferring patients from inpatient settings to more appropriate sites of care.

As CMS calls for a cut back in elective surgeries and other measures to ensure that hospitals have enough space and time to attend serious coronavirus cases, determining where to house patients as they recover and how to transfer them there has been a challenge.

Before the coronavirus reached community spread in the US, the municipality of Costa Mesa in California found itself locked in a legal battle with federal authorities regarding intentions to move fifty coronavirus patients into the city’s Fairview Developmental Center.

In February, emergency personnel asked a patient in Cleveland, Ohio suspected to have coronavirus to walk to a hospital, instead of taking their emergency transportation vehicle. They did not deem the vehicle ready to transfer him. Ultimately, the patient tested negative for the virus.

These cases highlight the severe need for quarantine space and communities’ anxieties about transferring and housing patients.

While these decisions to transfer patients to more appropriate sites of care are necessary, they have the potential to create gaps in communication and care when healthcare payers are not informed of where hospitals transfer their members. 

The payer organization asked that providers simply inform healthcare payers the next business day that a member has been transferred. In doing so, providers will enable proper care coordination and better ensure that providers will receive reimbursement for their care.

AHIP laid the responsibility for employing this strategy of informed transferral at the feet of health payer organizations.

One payer has already answered the call to act on this issue and support its providers in the difficult process of patient transfers.

The same day that AHIP’s board released its statement of commitment to healthcare providers, Cigna announced that it will take steps to improve the patient transfer process.

The payer has waived a number of measures in relation to transferring patients from inpatient settings to long term acute care hospitals.

Cigna waived prior authorizations on member transfers to long term acute care hospitals and in-network subacute facilities until May 31, instead requiring notification from the receiving institution the following business day.

“By accelerating the transfer of non-COVID patients out of hospitals and into long term acute care hospitals, we can free up space and beds, preserve supplies and ensure medical staff are available to treat COVID-19 patients that require immediate hospital care," said Steve Miller, MD, chief clinical officer at Cigna. "We are focused on taking quick, decisive actions to increase flexibility for hospitals and their teams of medical professionals, who are working tirelessly to help ensure all patients get the care they need during this unprecedented time."