CHA News

DMHC Proposes Emergency Regulations on Patient Transfers

For CEOs, CFOs, directors of reimbursement

This post has been archived and contains information that may be out of date.

On Jan. 12, the Department of Managed Health Care proposed adopting emergency regulations on the transfers of enrollees per state or local public health orders. Once approved by the Office of Administrative Law and filed with the Secretary of State, the regulations will be effective and remain in effect for 180 days.

The draft regulations state the following: 

  • An order issued by the state public health officer or a local health officer that directs or allows hospitals or other health care facilities to transfer patients to other facilities are covered by these regulations. 

  • Plans shall not require prior authorization or prior notice for a transfer and shall cover medically necessary costs of moving the enrollee between facilities. 

  • Plans must reimburse the receiving facility for all medically necessary services provided during the first 72 hours the enrollee is treated at the receiving facility. 

  • After 72 hours, the plan shall continue to reimburse the receiving facility for all medically necessary services if: 

    • The facility notifies the health plan that it is treating their enrollee within 72 hours of receiving the enrollee.

    • The plan does not disapprove of the facility’s request to continue providing medically necessary care for the enrollee. 

  • If the plan disapproves the request to continue providing care after 72 hours, it shall reimburse the facility for services up to the time the plan effectuates the enrollee’s transfer or is discharged from the receiving facility.