LH BULLETIN NO. 2020-06

To: All Health Insurance Companies, Health Maintenance Organizations and Other Interested Parties

From: Glen Mulready, Oklahoma Insurance Commissioner

Date: October 30, 2020

Re: Expediated Hospital Transfer Determinations

Throughout the COVID-19 pandemic health carriers and other industry representatives have responded to the Department’s request to address operational accommodations and adjustments related to the impact of the pandemic.  The response is acknowledged and appreciated.  The State of Oklahoma is again experiencing a surge of confirmed COVID-19 positive cases resulting in high hospitalization rates and challenging hospital capacity limits.

The Department is issuing this bulletin to regulated carriers and entities to assist with expediated authorizations dealing with patient transfers to other, in many cases, less intensive settings of acute care.

• All health carriers shall make transfer determinations within 24 hours upon request from an acute care hospital. Health carriers shall verify that operational capacity exists prior to transfer.

• To ensure the timely handling of transfer determinations, requests received late Friday or Saturday/Sunday will be prioritized for a Monday determination before addressing other requests for authorization to transfer a patient.

• When and where possible, carriers are instructed to work with discharge planning departments of acute care hospitals at the time of an insured patient’s admission to facilitate an understanding of the availability of needed or necessary hospital beds.

• Health carriers shall verify their provider networks are adequate to handle a potential increase in discharge determinations. If a health carrier does not have a provider or facility in-network with the appropriate capacity or experience to meet the particular health care needs of an insured, health carriers shall make exceptions to provide access to an out-of-network provider/facility at the in-network cost sharing level and include restrictions on balance billing.

• Medical transportation costs to transfer a patient from a hospital to a lesser intensive setting of care shall be paid by the carrier.  Transportation costs related to a lateral patient transfer between hospitals shall be negotiated between the sending and receiving hospitals and not cause the patient or carrier to bear the cost of the transportation.

The Department, in support and recognition of the Governor’s October 24, 2020 Executive Order – Sixth Amended Executive Order 2020-20, will continue to monitor the ongoing developments of the public emergency. Questions or comments applicable to this bulletin should be directed to the Legal Department at the Oklahoma Insurance Department, 400 NE 50^th Street, Oklahoma City, Oklahoma, 73105.