New York Gov. Kathy Hochul (D), signed an Executive Order, last week, to ease the Anticipated Staffing Challenges for Health Facilities, once the Vaccine Mandate's Deadline passed.

One Provision in the Order has Health Plans, Up-In Arms. What concerns Insurers is the Suspension of Requirements for Prior-Authorization Review for:

- Scheduled Surgeries

- Hospital Admissions

- Hospital Outpatient Services

- Home Health Services

- Inpatient/Outpatient Rehabilitation Services following Hospitalization

- Concurrent and Retrospective Review of Claims for Inpatient and Outpatient Services

In the Governor's Order, the Reason for the Suspension is to Increase Availability of Health Care Staff, who might otherwise have been engaged in Submitting or Processing those Tasks.

Another Provision also relieves Providers of Recordkeeping Requirements, such as assigning Billing Codes or Maintaining Records for Billing purposes.

Suspending the Prior-Authorization and Medical Review Requirements for about a Month, could Free-Up Thousands of Providers from Desk Duty responsibilities, said Kenneth Raske, President of the Greater New York Hospital Association (GNYHA), which represents over 250 Hospitals in New York. By Association estimates, there are over 3,000 Professionals in Downstate Hospitals doing such Tasks to Satisfy Paperwork Requirements from Health Plans, he said.

In a Memo GNYHA, sent out to Members last week, Raske noted that the Association had Strongly Advocated for those Suspensions. "We're committed to working with the government and administration to stop the spread, but we are concerned with the impact of these provisions on patient care," said Eric Linzer, President of the New York Health Plan Association (NYHPA), which Represents over 28 Insurers.

These Prior-Authorization Reviews are important for Post-Acute-Care Planning, and Care Managers will find it Hard to ensure Continuity of Service without them, Linzer said.

Linzer questioned the need for the Suspension in the first place. When the State Vaccine Mandate Deadline hit Sept. 27th, Hospitals claimed High Rates of Vaccination and said they were able to Maintain their Full Spectrum of Services, he said. "If we're not seeing the staffing issues that had been anticipated, why move forward with this?" he asked.

The Insurer Organization is seeking Clarity from Hochul's Office on the Implementation of the Suspensions, Linzer said.

The Executive Order requires Hospitals to Certify to Health Plans that they are facing Staffing Challenges and thus require the Suspensions.

"This temporary provision provides an option for facilities to dedicate more clinical staff for direct patient care if necessary to address a shortage," said Hazel Crampton-Hays, Press Secretary for Hochul's Office. "Ensuring access to quality care is everyone’s primary concern."

Bill Hammond, Senior Fellow for Health Policy, at the Albany Think Tank Empire Center, wrote in a Post that Hospitals had sought similar Restrictions in the Past as a way of Increasing Revenue rather than Freeing-Up Staff. This included a "Pay and Pursue" Bill lobbied by the Hospital Industry this year, that Required Insurers to Pay Claims Upfront and Dispute Discrepancies After.

"The executive order gives them a partial, temporary victory on the same front," Hammond said.










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