Insights

Insurers Encouraged to Waive Certain Prior Authorization Requirements


On August 13, 2021, the Department of Insurance issued Directive 217, which asks health insurance issuers and HMOs to evaluate coverage for treatment in place by emergency medical services personnel and to consider waiving prior authorization requirements for certain services and items related to COVID-19.

The directive explains that in light of CMS's waiver permitting reimbursement for treatment in place (under Medicare) and given that this strategy can divert patients from hospitals while providing the necessary care to the patient, insurers are directed to consider adopting coverage accordingly. "Treatment in place" means that EMS applies protocols to evaluate and treat a patient at the scene of the EMS transportation request (rather than transporting the patient to a facility for care). In further efforts to ease burdens on hospital occupancy, the directive encourages insurers to waive prior authorization requirements for certain services and items related to COVID-19 that are necessary to discharge patients to their homes (e.g., oxygen supplies).

Insurers and HMOs are encouraged to maintain the requested changes at least until the current surge of COVID-19 cases in the state decreases back to the rates of early July.

While this guidance applies to insurers, employers should be aware of these developments.

Directive 217 »