COVID-19 – Utilization Management Changes

Jan 21, 2022

During this latest significant surge of COVID-19, Kaiser Permanente is committed to ensuring our members receive the right care, at the right time, in the right place. To help reduce the administrative burden on hospitals in Maryland and eliminate barriers to timely, safe transitions of care, Kaiser Permanente is temporarily revising our utilization management policies and practices. These temporary policy changes are effective immediately and will run through February 15, 2022. These changes are intended to expedite transitions of care and help make resources available, so hospital staff and providers can care for patients when they need it most.

Below are the immediate changes Kaiser Permanente is implementing in the state of Maryland.

Prior Authorization and Concurrent Review Process –
Effective immediately, through February 15, 2022, Kaiser Permanente is revising our admission and concurrent review processes. The temporary utilization management policies described below apply to all Kaiser Permanente lines of business.

Kaiser Permanente will waive prior authorization requirements for hospital admissions and will revise admission notification requirements from 24 hours to 72 hours from the time of admission.

Concurrent Review Process
To ensure expedited, timely transitions of care, Kaiser Permanente will continue concurrent review processes. However, our clinical document submission requirement will be revised from daily, to every 72 hours.

Facility to Facility Transfers
We are adjusting our required notification of admission to acute-to-acute, Behavioral Health, and Inpatient Hospice from 24 hours to 72 hours. Skilled Nursing, Acute Rehab, and Long Term Acute Care Hospital will require prior authorization.

As we work through this emergency period, we are engaging with our hospital partners to ensure rigorous discharge planning for each member. Our goal is to support our hospitals in expediting safe transitions of our members to the right care, at the right time, in the right place.

We expect the above protocol to be in place through February 15, 2022. However, we will continue to monitor guidance issued by regulatory authorities and will update this information as the COVID-19 crisis evolves.

Recent Posts