December 23, 2021
Due to increased demand for inpatient care at acute care facilities (ACFs) during the current public health emergency, the New Mexico Office of Superintendent of Insurance (OSI) and Human Services Department (HSD) have issued emergency orders suspending prior authorization requirements for the transfer of patients from an ACF to a Skilled Nursing Facility (SNF) or Long-Term Care (LTC) facility. The OSI’s emergency order, effective as of December 6, 2021, and HSD’s emergency order, effective December 7, 2021, will remain in effect until the end of the public health emergency or until the emergency orders are terminated, whichever occurs first.
Based on these orders and in further recognition of bed-needs within New Mexico’s ACFs, Blue Cross and Blue Shield of New Mexico (BCBSNM) has suspended its prior authorization requirements for transfers of all BCBSNM members from ACFs to SNFs and LTCs, with the exceptions of Federal Employee Program members and members of other Blue Cross and Blue Shield plans. All other prior authorization requirements remain in effect, including but in no way limited to concurrent review.
For the purposes of this suspension, BCBSNM will consider ACFs to include general acute care hospitals and long-term acute care hospitals, and LTCs to include long-term acute care hospitals, rehabilitation hospitals, and nursing facilities. Please note that inclusion of a provider type in this suspension of prior authorization does not change any other terms of coverage. For example, nursing facility services may be covered under the terms of a Medicaid plan, but may not be covered under the terms of a commercial plan. Coverage will continue to be determined by the terms and conditions of each member’s specific health care benefits plan.
Providers must notify BCBSNM of a patient transfer to an SNF or LTC facility within a certain number of days of the patient’s admission. BCBSNM must be notified within 10 calendar days of admission for the transfer of Medicaid recipients, and for all other lines of business, BCBSNM must be notified within three calendar days of admission. BCBSNM will continue to engage in care management functions, including utilization review, after the patient transfers to an SNF or LTC facility. Additionally, providers are reminded to utilize BCBSNM-participating SNF and LTC facilities for transfers where and when those facilities are available and appropriate.
Information regarding any additional changes to prior authorization requirements for ACF transfers, whether by mandate or otherwise, will be communicated to providers through at least this same channel.
BCBSNM Network Services Department