ALBANY – Business groups and the insurance industry say a state directive temporarily suspending the pre-authorization requirement for surgeries and other medical procedures is likely to increase the cost of health care plans for them. employers and their staff.
Under a general directive issued by Gov. Kathy Hochul’s administration last week, a requirement that health insurance claims be reviewed by health plans both retrospectively and simultaneously has also been waived.
Hochul officials called the move a “bold move” to address shortages in staff and other health facilities. These staffing issues have been exacerbated by Hochul’s mandate that all healthcare workers receive COVID-19 vaccines.
Lev Ginsburg, senior director of government affairs for the Business Council of New York State, a group that advocates for employers, told CNHI that the insurance pre-authorization requirement “serves as a check and balance for the cost of care health “because she ensured the procedures performed in hospitals and health clinics are medically necessary. Not having the requirement in place will increase the cost of healthcare, he argued.
The fact that employers are very concerned about the state directive shows that the issue is not just about another disagreement between insurers and the hospital lobby, but that it is a consumer issue. much wider, Ginsburg said.
Hochul’s emergency order is due to expire on October 27.
It contained several other provisions, such as licensing doctors and other health care professionals from other states to practice in New York.
The directive suspending pre-authorization exams has been requested by the Greater New York Hospital Association.
The industry group praised Hochul for its “decisive action” in suspending the pre-authorization review and other provisions of the state insurance law.
Eric Linzer, president of the New York Health Plan Association, said it was an “open question” as to the extent of the hospital staff shortages being used as the justification for Hochul’s emergency order.
Linzer noted that there had been reports by the time the order was issued last week that hospitals “continued to provide the full range of care” to patients in their facilities.
He also said the order could end up having “adverse effects” on patients discharged from hospitals, as insurers will not be able to determine whether there are “the necessary supports in place for follow-up care and their recovery “.
Gary Fitzgerald, president of the Iroquois Healthcare Alliance, a coordinating group of around 50 hospitals in the upstate, said the healthcare administrators he consulted with on a daily basis fully supported the order.
“We currently have a serious staff shortage, and anything that makes caregiving easier and doesn’t jump in the hoops during this time of crisis is welcome,” Fitzgerald said in an interview.
Bill Hammond, health policy researcher for the Empire Center for Public Policy, an Albany think tank, said if staff shortages had worsened due to the vaccine mandate, Hochul could have simply suspended this mandate instead of suspending the screening requirement.
Hammond also said that it is likely that hospitals that do not have staff shortages will now invoke the emergency order to “escape the standard, routine monitoring of their billing which is absolutely important to maintaining integrity. of the insurance system “.
The Greater New York Hospital Association has informed its members that the state ordinance includes other “flexibilities” that give hospitals and nursing homes the power to discharge, transfer and admit patients on duty. staff shortages, as authorized by the state health department.
“Doctors can make visits to residents of nursing homes via telemedicine,” the association advised. “Some record keeping requirements are suspended.”
The order should remain in effect until the current expiration date.
“This temporary arrangement gives facilities the flexibility to dedicate more clinical staff to direct patient care if needed to address a shortage,” said Hochul spokeswoman Hazel Crampton-Hays. “Guaranteeing access to quality healthcare is everyone’s main concern.
The health care vaccination mandate went into effect on September 27 – the same day the emergency order was issued.