Continued Access to Care for Covered Persons Impacted by the Closing of Carney Hospital and Nashoba Valley Medical Center
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This bulletin directs Massachusetts commercial health insurers, HMOs, and Blue Cross Blue Shield of MA to relax prior authorization and credentialing processes and assist covered persons affected by the closures of Carney Hospital and Nashoba Valley Medical Center to ensure continued access to care.
No material clinical or coverage changes in this revision.
Carrier Expectations for Continuity of Care
Carrier operational expectations
Carrier expectations to assist covered persons impacted by the facility closures include:
Temporary Flexibilities and Operational Steps for Carriers and Providers
Temporary prior authorization relief
For 60 days after the Bulletin issuance, carriers should forego prior authorization reviews for any previously approved surgeries, procedures, and behavioral health or non-behavioral health admissions at the closing facilities that require transfer, when provided the updated location and date of service.
Non‑network placement and cost‑sharing guidance
If an alternate network facility is not available before the next scheduled stay or within five business days of initiating the search, carriers must use best efforts to locate non‑network facilities and inform impacted persons that they will be held to their plan's in‑network cost‑sharing.
- Applies to persons in inpatient beds or in active outpatient treatment at the closing facilities for 60 days after the Bulletin issuance.
- Carriers must notify impacted persons that they will only be subject to in‑network cost‑sharing when a non‑network facility is located.
Notification and updates from facilities
Acute care hospitals, mental health hospitals (including freestanding psychiatric and SUD facilities), and post‑acute facilities must notify carriers of inpatient admissions within 24 hours and provide updates at least every five days to support discharge planning.
- Timely notification and ongoing updates enable carriers to coordinate medically necessary care and find alternate network placements during the 60‑day period.
- Updates are required at a minimum frequency of every five (5) days for admitted patients.
Key Definitions
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