Clinical review requirements suspended for admission to skilled nursing facilities from certain hospitals at higher inpatient bed occupancy

Effective April 12 through May 31, 2021, Blue Cross Blue Shield of Michigan and Blue Care Network are temporarily suspending clinical review requirements for admission to skilled nursing facilities from those hospitals most impacted by the current surge in COVID-19 cases.

This temporary change applies to all lines of business, including Blue Cross commercial, Blue Care Network commercial, Medicare Plus Blue^SM and BCN Advantage^SM.

The suspending of clinical review for SNF admissions applies to patients transferring from a hospital with inpatient bed occupancy at 85% or higher. Blue Cross and BCN will monitor hospital occupancy based on data from the Michigan Department of Health & Human Services. This information can be found on the Statewide Available PPE and Bed Tracking webpage* on the Michigan.gov website (see the Patient Census chart at the bottom). Blue Cross and BCN will check this list weekly and add hospitals whose inpatient bed occupancy meets or exceeds 85%.

Please see the Temporary suspension of clinical review requirements to a skilled nursing facility (PDF) which lists the current hospitals who have the clinical review requirements suspended for admissions to SNFs. This document can be found within Provider Secured Services by clicking Coronavirus (COVID-19). It is posted under the Utilization management section.

Note:

• Admissions to skilled nursing facilities from the hospitals that qualify for accommodations based on bed occupancy will auto-approve the first three days. For these admissions, clinical documentation will not be required until the continued stay review, starting on the fourth day of stay.
• Long-term acute care hospital and inpatient rehabilitation facility admissions from the hospitals who qualify for accommodations based on bed occupancy will receive expedited processing requests submitted during normal business hours. Clinical review is still required.
• This temporary change does not apply to FlexLink^® groups for which a third-party administrator makes authorization determinations. Facilities should check the back of the member's ID card to determine whether a third-party administrator needs to be contacted prior to an admission.

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Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network