Clinical review requirements suspended for admission to skilled nursing facilities from all Michigan hospitals due to latest COVID-19 surge

Effective Sept. 20, 2021 and until further notice, Blue Cross Blue Shield of Michigan and Blue Care Network are temporarily suspending clinical review requirements for the first three days of admission to skilled nursing facilities from all Michigan hospitals due to the latest surge in COVID-19 cases. This temporary change applies to all lines of business, including Blue Cross Blue Shield of Michigan commercial, Blue Care Network commercial, Medicare Plus Blue^SM and BCN Advantage^SM.

Blue Cross and BCN began suspending clinical review requirements for the first three days of admission to skilled nursing facilities Sept. 1, for those states most impacted by the surge in COVID-19 cases. For the list of states with this clinical review suspension, refer to the UPDATE: Clinical review requirements temporarily suspended for admissions to skilled nursing facilities from hospitals in certain states (PDF).

Information you need to know

• Admissions to skilled nursing facilities from Michigan hospitals and hospitals in certain other states will auto-approve the first three days. Clinical documentation is not required until the continued stay review, starting on the fourth day of stay.
• This temporary change does not apply to Blue Cross Blue Shield of Michigan commercial FlexLink^® groups for which a third-party administrator makes authorization determinations. Facilities should check the back of the member's ID card to determine whether a third-party administrator needs to be contacted prior to an admission.
• Long-term acute care hospital and inpatient rehabilitation facility admissions still require clinical review.

Posted: September 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network