State Calls for Insurance Flexibility During Carney, Nashoba Closures

DOI Issued Official Bulletin On Friday

State officials have instructed health insurers to be flexible with handling prior authorizations for patients and credentialing health care workers who are impacted by the impending closures of Carney Hospital and Nashoba Valley Medical Center.

In a Friday bulletin, the Division of Insurance said it expects commercial health insurers, health maintenance organizations, and Blue Cross Blue Shield of Massachusetts to waive prior authorization reviews for 60 days for “any previously approved surgeries, procedures and behavioral health or non-behavioral health admissions at Carney Hospital and Nashoba Valley Medical Center that need to be transferred to another facility upon notice of the updated location and date of service.”

The flexibility applies to inpatient and outpatient surgical treatments that had been scheduled at Carney and Nashoba, according to the bulletin, which was circulated Monday by the Massachusetts Health and Hospital Association.

Over the next 60 days, insurers should be “actively involved” with helping to coordinate alternative care for patients who are being treated at Carney or Nashoba, including those in inpatient beds or going through outpatient treatment, according to the bulletin.

Steward Health Care plans to close the Carney and Nashoba facilities on or around Aug. 31.

As health care workers at Carney and Nashoba find employment at other health care systems, DOI has asked insurers to make adjustments to their credentialing policies to expedite the process for individuals who “are seeking to be newly credentialed by a Carrier, or who are seeking to modify the materials that are part of an existing credentialing file,” according to the bulletin.

A MassHealth memo sent Friday outlined similar prior authorization flexibilities connected to Carney and Nashoba, in addition to accelerating the credentialing process for workers joining other hospitals or provider systems.

“For 60 days after the issuance of this bulletin, MassHealth will transfer prior authorizations and pre-admission screenings for any previously approved surgeries, procedures, and behavioral health or non-behavioral health admissions at Carney Hospital and Nashoba Valley Medical Center that need to be transferred to another facility,” the memo said.