Currentculinary health fundPolicy N/A

Culinary Health Fund COVID-19 Elective Procedure Authorization Changes

Notice to Culinary Health Fund providers that, effective immediately (March 16, 2020), authorizations for non-essential, elective procedures will not be processed; requests for procedures deemed essential may still be submitted for review.

Policy Summary

Payerculinary health fund

PolicyCulinary Health Fund COVID-19 Elective Procedure Authorization Changes

Policy CodePolicy N/A

Change TypeAuthorization suspension for non-essential elective procedures

Effective DateMar 16, 2020

Next Review Date

Key ActionDo not expect authorizations for non-essential elective procedures to be processed; submit authorization requests only for procedures believed to be essential and document clinical necessity for review by Nevada Health Solutions.

SourceLink

POLICY UPDATE CHANGES

Effective immediately, Culinary Health Fund will not process authorizations for non-essential, elective procedures.

1Policy Action Items

Non-essentialAuthorizations suspended

EssentialAuthorizations considered case-by-case

What is changing

Due to the COVID-19 pandemic and CDC recommendations to preserve healthcare capacity and personal protective equipment (PPE), the Culinary Health Fund has suspended processing of authorizations for non-essential, elective procedures to support acute care needs. Notice to Culinary Health Fund providers that, effective immediately (March 16, 2020), authorizations for non-essential, elective procedures will not be processed; requests for procedures deemed essential may still be submitted for review.

Effective immediately, Culinary Health Fund will not process authorizations for non-essential, elective procedures.

Providers may submit authorization requests for procedures they consider essential/critical; these will be reviewed by Nevada Health Solutions on a case-by-case basis.

The suspension will be reassessed continually as the pandemic evolves and providers will be notified when changes occur.

Authorization processing policy

Authorization Processing Policy during COVID-19

Effective immediately, authorization processing follows the logic below:

ALL of the following

Procedure type
- Non-essential, elective procedures — authorizations will NOT be processed.
- Essential/critical procedures — if believed to be essential and must be performed now, providers should notify Nevada Health Solutions with an authorization request for case-by-case review.
Policy applies to Culinary Health Fund participants and their providers; reassessment will occur as the pandemic evolves and notifications will be sent when changes occur.

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Non-essential, elective procedures — Procedures that are not critical or essential to immediate patient health and can be delayed without significant harm; authorizations for these procedures will not be processed.

Essential/critical procedures — Procedures believed by the treating provider to be critical to the patient’s health and that must be performed now; providers should notify Nevada Health Solutions and submit an authorization request for case-by-case review.

What providers must do

Prior Authorization

Do not submit routine elective authorizations

Do not expect authorizations for non-essential elective procedures to be processed; such requests will not be processed effective immediately (March 16, 2020).

Prior Authorization

Submit authorization for essential procedures only

If a procedure is believed to be essential/critical to the patient's health and must be performed now, notify Nevada Health Solutions and submit an authorization request for review.

Documentation Required

Document clinical necessity for essential cases

Providers should document why the procedure is essential/critical and include this rationale when submitting an authorization request to Nevada Health Solutions.

Note

Stay informed via public health guidance

Monitor CDC and Southern Nevada Health District guidance linked in the notice for evolving recommendations and contact information for COVID-19 inquiries.

Definitions and frequently asked questions

Can providers still submit authorization requests? — Yes. However, authorizations for non-essential elective procedures will not be processed; submit requests only for procedures deemed essential/critical with documentation to support urgency, and notify Nevada Health Solutions for case-by-case review.

How will I know when the policy changes? — The Culinary Health Fund will reassess continually and send notifications when any changes occur; providers should also monitor CDC and Southern Nevada Health District guidance.

Non-essential, elective procedures — Procedures that are not critical or essential to immediate patient health and can be delayed without significant harm.

Essential/critical procedures — Procedures believed by the treating provider to be critical to the health of the patient and that must be performed now; these require case-by-case authorization review.

Change log

2020-03-16Policy changeLatest