AHIP recommends insurers give 90-day grace period for pre-authorized procedures

As the country begins to move towards reopening the healthcare system and economy, America's Health Insurance Plans Board of Directors is encouraging health insurers to implement grace periods that would extend approvals for approved surgeries and procedures prior to the national emergency declaration on March 13.

These are for surgeries and procedures that were pre-authorized and approved but subsequently postponed due to COVID-19. The grace period will enable surgeries and procedures to be scheduled without having to be reauthorized.

AHIP encourages approvals to be valid for at least 90 days or until the local backlogs are cleared.

Another AHIP recommendation promotes the continued widespread adoption and use of telemedicine that increased during the pandemic.

During COVID-19, insurers also relaxed standards for prior authorization, especially between acute and post-acute care, to more quickly free up hospital bed space.

AHIP recommends insurers continue to enhance efficiency and streamline  administrative processes, including prior authorization, while still promoting safe, timely, and affordable evidence-based care.

However, there is an expected return to former precertification and prior authorization standards that were relaxed under COVID-19.

For patient transitions from inpatient to post-acute care settings, this includes resuming prior authorization where feasible while committing to continue to accommodate providers who may have continued capacity challenges, AHIP said.

"As non-COVID-related care resumes, insurance providers will continue to streamline the use of prior authorization in an appropriate manner, such as through automation, electronic information exchange, programs that identify high-performing clinicians, and value-based provider contracts that incent reductions in unnecessary medical tests, treatments and procedures," AHIP said.

Other AHIP recommendations include the resumption of routine and preventative care, including dental care, and testing innovative payment models to advance evidence-based care for newly diagnosed conditions, prescribed care and treatments.

WHY THIS MATTERS

Many different types of care -- from elective surgeries and non-urgent procedures, to primary and preventive care -- were delayed to protect patients, healthcare workers and first responders from COVID-19 exposure and to conserve limited supplies of personal protective equipment.

As many states allow healthcare services to resume, AHIP said insurers, as well as health systems and physicians, will ensure that preventive care, less urgent care and elective surgeries are provided, following Centers for Disease Control and Prevention guidelines to reduce the likelihood of virus transmission.

THE LARGER TREND

Health insurers have waived patient costs for COVID-19 testing and treatment and eliminated many administrative requirements related to COVID-19.

Insurers were partly mandated for coverage under the CURES Act and an earlier Families First bill.

But some insurers, including Aetna and Humana, elected to cover inpatient stays for patients affected by COVID-19. 
 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com