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Federal CMS and Louisiana State Emergency Rule 41: Medical Surge-Related Patient Transfers

April 03, 2020

Federal CMS and Louisiana State Emergency Rule 41: Medical Surge-Related Patient Transfers

On March 30, 2020 CMS issued this newsroom factsheet that points to this guidance, Hospitals: CMS Flexibilities to Fight COVID-19, providing additional flexibilities for hospitals to set up temporary expansion sites to increase capacity to care for patients. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.

On March 31, 2020, Louisiana issued Emergency Rule 41. Acute care hospitals in heavily affected areas are increasingly tasked with transferring patients to other facilities to maximize beds and supplies. Step-down facilities, as defined under the rule, is any healthcare facility serving as the recipient of inpatient transfers for the purpose of reducing occupancy of or providing overflow capacity for an acute care hospital during the state of emergency. These transfers, however, can be prohibitive by health insurance issuers’ limitations in which facilities are eligible as a step-down facility and some of the pre-authorizations, utilization and necessity requirements. Emergency Rule 41 addresses this problem in part. It became effective on March 31, 2020 and shall continue during this public health emergency or May 12, 2020, whichever is earlier.

Under the Louisiana Rule, health insurance issuers:

  • Shall not impose prior authorization, utilization, medical necessity or any related review on the transfer of patient from an acute care hospital to a step-down facility and shall not engage in post-service reviews of transfers of patients from an acute care hospital to a step-down facility
    • This does not prevent the health insurance issuer from applying its existing utilization review policies to the underlying provision of care when permissible
  • Shall cover remainder of the inpatient stay needed after transfer under terms and at a cost sharing rate no less favorable to the insured than those that would have applied had the insured remained at the acute care hospital
    • This does not require health insurance issuers to reimbursement government-sponsored step-down facilities
  • Shall be subject to regulatory action for violations to this rule.

For more information, read the rule here

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