This bulletin is directed to all insurers issuing accident and sickness insurance policies, as defined at IC 27-8-5-1, and all health maintenance organizations (HMOs), as defined at IC 27-13-1-19 (collectively, "insurers"), that issue major medical plans in compliance with the Affordable Care Act (ACA) and short-term, limited-duration plans in the individual and group markets are subject to this bulletin. This bulletin is also applicable to insurers subject to the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Due to the declaration of a public health emergency throughout the state of Indiana as a result of the Coronavirus Disease 2019 (COVID-19) and the issuance of Governor Holcomb's Executive Order 21-24, on September 1, 2021, the Indiana Department of Insurance (IDOI) issues this bulletin to extend its position on certain prior authorization requirements as initially announced in Bulletin 255.

Due to a rise in COVID-19 cases, increased demands are straining hospital systems throughout the state. To increase the number of hospitals beds and staff available to combat the COVID-19 public health emergency, the IDOI strongly encourages insurers to waive clinical information requirements for prior authorizations where doing so will expedite and facilitate the transfer or discharge of patients to the most appropriate setting, including post-acute placement. Insurers may require a prior authorization form to be submitted but should waive the clinical information requirements for the prior authorization through September 30, 2021. After such period of time has expired, insurers may require the provider or facility to submit clinical information for subsequent prior authorizations. IDOI requests insurers prioritize timely responses to prior authorization requests to facilitate patient transfers.

Information regarding the daily statewide cases of COVID-19 may be found at https://www.coronavirus.in.gov/index.htm.

Questions regarding this bulletin should be directed to Heather Alford at halford@idoi.in.gov.

INDIANA DEPARTMENT OF INSURANCE

Amy L. Beard

Insurance Commissioner

DIN: 20210908-IR-760210393NRA

Composed: May 09,2024 1:54:18AM EDT

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