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Morris Manning & Martin, LLP

Reissuing Temporary Suspension of Certain Concurrent and Utilization Review Requirements

02.25.2021

Georgia hospitals are experiencing extreme demand due to the COVID-19 pandemic. Making the situation more dire, hospitals are also experiencing staff shortages. It has become apparent a quick way to free clinical staff to support patient care in facilities is by suspending requirements around concurrent and utilization review so that staff who may handle review functions could be re-deployed to assist with the increased demand for services. Given the current situation in Georgia’s hospitals, any clinical staff who can be doing clinical work should be doing so.

Suspension of Preauthorization Requirements for Scheduled Surgeries or Admissions at Hospitals

The Department of Insurance (Department) is advising issuers that they should suspend preauthorization review for scheduled surgeries or admissions at hospitals for 30 days from the date of this letter, subject to further evaluation as the COVID-19 situation develops. However, hospitals should use their best efforts to provide 48 hours’ notice to the issuer after admission to a hospital, including information necessary for an issuer to assist in coordinating care and discharge planning.

Suspension of Concurrent Review for Inpatient Hospital Services

Hospitals may lack the resources for staff to respond to utilization review requests for concurrent review while responding to the surge in patients due to COVID-19. Therefore, the Department is advising issuers that they should suspend concurrent review for inpatient hospital services provided for 30 days from the date of this Directive, subject to further evaluation as the COVID-19 situation develops.

Applicability to Third-Party Administrators of Self-Funded Plans

Adherence to this Directive is essential to ensure that hospitals are able to direct resources to patient care to handle increases in patient volume due to the COVID-19 state of emergency. Third-party administrators, which are licensed by the Department as independent adjusters, are strongly encouraged to apply the provisions of this circular letter to their administrative services arrangements with self-funded plans.