Discharge Planning

Discharge planning begins at the time of admission and is a collaborative effort involving:  

• Member  
• Family members  
• Primary care physician  
• Specialist  
• Hospital discharge planning staff  
• Ancillary providers, as necessary  

BCBSNE monitors all hospitalized members to assess their readiness for discharge and assist with post-hospital arrangements to continue their care. The goal is to begin discharge planning before or at the beginning of the hospital stay. BCBSNE nurses work in conjunction with members’ primary care physicians to authorize and coordinate post-hospital needs, such as home health care, durable medical equipment and skilled nursing placement. For these members, providers should follow the processes described in the “Guidelines for care transition” section of this chapter.  

Note: Only Acute Care, Skilled Nursing Long Term Acute Care and Inpatient rehabilitation facilities require pre-authorization.  

Requesting an Expedited Decision  
Either the physician or the Medicare Advantage member may request an expedited decision if they believe that waiting for a standard decision could or would do one of the following:  

• Seriously harm the life or health of the member  
• Seriously compromise the ability of the member to regain maximum function  
• Subject the member to severe pain that cannot be adequately managed with the care or treatment that is being requested 

BCBSNE relies on the physician to determine conditions that warrant expedited decisions.  

• If the physician requests an expedited decision, the decision is made according to preservice urgent time frames.  
• If the member requests an expedited decision, BCBSNE calls the physician to determine whether the member’s medical condition requires a fast decision.  
• If the physician agrees, BCBSNE makes a decision to approve or deny the request according to preservice urgent time frames (see table found under the subheading “Standard time frames Medicare Advantage members”).  
  • If the physician disagrees, BCBSNE makes a decision according to standard time frames (see table above) and notifies the member of a decision not to make an expedited decision.  
  • BCBSNE will not make an expedited decision about payment for care the member has already received.  

Expedited requests must be submitted by telephone to 877-399-1671.