The recent surge in cases related to the Delta variant of COVID-19 is placing a strain on the capacity of hospitals and other healthcare facilities equipped to treat patients with COVID-19. In addition, workforce shortages and capacity issues are leading to a shortage of the availability of post-acute care facilities, such as nursing homes and skilled-nursing facilities. As a result, patients that no longer need acute care are being housed at hospitals when they would normally be discharged to a post-acute care facility. This is placing further strain on capacity issues as it limits the amount of beds and staff available to treat COVID-19 and other conditions requiring acute care.
For this reason, OCI is requesting that Health Plan Issuers work with healthcare facilities facing capacity issues to remove any barriers to transferring patients to other facilities for their post-acute care. OCI is strongly encouraging Health Plan Issuers to remove or streamline any prior authorization requirements and consider coverage for out-of-network facilities where in-network facilities are unavailable. OCI also requests that insurers consider providing coverage for swing bed programs, both within the initial hospital's facility and allowing a hospital to utilize unused patient capacity at other hospitals.
Where appropriate, Health Plan Issuers are strongly encouraged to not deny coverage for a treatment or service provided at a post-acute care facility when a patient was transferred to relieve capacity strains. OCI also requests that insurers consider waiving any additional charges patients may incur for receiving treatment at a non-network facility.
These requests for coverage only apply to healthcare facilities and areas of the state that are experiencing capacity shortages due to the number of people needing care for COVID-19 and other conditions that require acute care.
Any questions concerning this bulletin should be directed to Nathan Houdek at
Nathan.Houdek@wisconsin.gov.