AmeriHealth Caritas Ohio will be temporarily waiving prior authorization requirements for inpatient to nursing home transfers through March 9. This flexibility is vital to managing the current surge in patient volume and ensuring our healthcare system can continue to provide timely care to those in need.
Prior authorization requests, including appropriate clinical information, should still be submitted during this time and requests will be reviewed same day or automatically approved.
Ohio is currently experiencing an exceptionally high and rapidly increasing rate of hospitalization due to influenza, placing significant strain on our healthcare system. The impact is especially pronounced in our hospitals’ ability to continue providing care to new patients. In the Cincinnati area alone, providers have reported that as of the end of last week, there were 230 patients waiting in emergency departments for inpatient beds. A portion of these inpatient beds are occupied by patients awaiting transfer to nursing homes, which requires pre-certification approval.
The resulting backlog of emergency department boarders is creating a bottleneck that not only fills up emergency departments but also makes it increasingly difficult to care for incoming patients. As a result, several hospitals have been forced to go on diversion.
The temporary waiver aligns with action taken in previous periods of high-volume hospitalizations, such as during COVID-19 surges to enable quicker transitions for patients from inpatient beds to nursing homes. This waiver played a critical role in freeing up hospital beds and alleviating pressure on emergency departments, enabling hospitals to care for more acute patients.
To help monitor the ongoing situation, your teams can refer to the Ohio Department of Health’s Seasonal Influenza Activity Report for up-to-date regional data on flu trends: Seasonal Influenza Activity Report | Ohio Department of Health.
