Provider Update – Special Edition December 2022 (Revised 3/9/23)
Posted on March 9, 2023
We are happy to share with you this Special Edition December 2022 to update you on good faith admissions to skilled nursing and acute rehabilitation facilities from the acute care setting.
Acute Care Setting to Skilled Nursing and Acute Rehab Facilitates
Effective December 6, 2022 – April 20, 2023 for our Commercial (fully funded)*, BeHealthy Partnership® and Medicare Advantage members, Health New England will:
- Allow good faith admissions to skilled nursing facilities and acute rehabilitation facilities from the acute care setting without prior authorization.
- Cover the initial 3 days of the SNF/acute rehab stay.
- Conduct retrospective and concurrent review during this time period to determine appropriateness of level of care.
In addition, the Post Acute Facility (Skilled Nursing Facility/Acute Rehab) will:
- Notify Health New England of a good faith admission to their facility with 24 hours of the member’s admission.
- Provide updates, at a minimum of every 5 days, to support discharge planning.
*This may be applicable to some self-funded employer groups. Please call Member Services at (800) 842-4464 extension 5025 to understand benefits.
If you have any questions about the information in this notice, please contact Health New England Provider Relations at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. You may also send an email to providerrelations@hne.com.
Editor’s Note: This post was originally published on December 28, 2022, and has been revised and updated for accuracy.
