Clinical review requirements for admission to skilled nursing facilities from Michigan hospitals suspended

As we wrote in a web-DENIS message posted Sept. 2, Blue Cross Blue Shield of Michigan and Blue Care Network are temporarily suspending clinical review requirements for the first three days of admission to skilled nursing facilities from all Michigan hospitals due to the latest surge in COVID-19 cases.

This temporary change was effective Sept. 20, 2021, and will remain in effect until further notice. It applies to all lines of business, including Blue Cross Blue Shield of Michigan commercial, Blue Care Network commercial, Medicare Plus Blue℠ and BCN Advantage℠.

Blue Cross and BCN began suspending clinical review requirements for the first three days of admission to skilled nursing facilities Sept. 1 for states most affected by the surge in COVID-19 cases. For the list of states with this clinical review suspension, refer to this Provider Alert.

Information you need to know

• Admissions to skilled nursing facilities from Michigan hospitals and hospitals in certain other states will auto-approve the first three days. Clinical documentation isn’t required until the continued stay review, starting on the fourth day of stay.
• This temporary change doesn’t apply to Blue Cross Blue Shield of Michigan commercial 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.
• Long-term acute care hospital and inpatient rehabilitation facility admissions still require clinical review.

The information in this article was valid as of Oct. 14. It’s possible that the suspension may be lifted prior to the publication of the November Record.