Supplement No. 1 to Insurance Circular Letter No. 1 (2022)
February 3, 2022
|TO:||All Insurers Authorized to Write Accident and Health Insurance in New York State, Article 43 Corporations, Health Maintenance Organizations, Student Health Plans Certified Pursuant to Insurance Law § 1124, Municipal Cooperative Health Benefit Plans, Prepaid Health Services Plans, Utilization Review Agents, and Licensed Independent Adjusters|
|RE:||Coronavirus and the Suspension of Certain Utilization Review Requirements|
STATUTORY REFERENCES: N.Y. Insurance Law §§ 3216, 3217-d, 3221, 4303, 4306, 4902, and 4903; and N.Y. Public Health Law §§ 4403, 4902, and 4903
As set forth in Insurance Circular Letter No. 1 (2022) (“Circular Letter”), Coronavirus disease 2019 (“COVID-19”) cases continue to strain health care delivery systems. In order to keep pace with the increased demand for inpatient hospital care while facing staffing shortages, hospitals continue to need to quickly transfer patients between hospitals and, when appropriate, discharge patients to skilled nursing facilities in order to increase bed capacity and balance patient load. The Circular Letter advised insurers authorized to write accident and health insurance in this state, Article 43 corporations, health maintenance organizations, student health plans certified pursuant to Insurance Law § 1124, municipal cooperative health benefit plans, and prepaid health services plans with respect to commercial coverage, Child Health Plus, Essential Plan, and Medicaid managed care coverage (collectively “issuers”), independent agents performing utilization review under contracts with such issuers, and licensed independent adjusters to suspend certain utilization review requirements so that hospitals could quickly transfer or discharge insureds, as medically appropriate.
In order to continue to assist hospitals, the purpose of this Supplement to the Circular Letter is to advise issuers that they should continue to suspend preauthorization requirements for insured transfers between in-network hospitals and preauthorization requirements for in-network inpatient rehabilitation services following an inpatient hospital stay as set forth in the Circular Letter until February 28, 2022. The Department of Financial Services (“Department”) also continues to strongly encourage issuers offering Medicare Advantage plans to apply the provisions of the Circular Letter to such plans. In addition, third-party administrators licensed by the Department as independent adjusters also are strongly encouraged to continue to apply the provisions of the Circular Letter to their administrative service arrangements with self-funded plans.
Please direct any questions regarding this circular letter by email to [email protected].
Very truly yours,
Chief, Health Bureau