MHA, Health Plans Issue ED Boarding Communication Plan

Emergency department (ED) boarding for patients in need of inpatient psychiatric and substance use disorder services is a problem that the state, providers, health insurers, and  patient advocates have been attempting to resolve for several years. In discussions, one issue raised as a contributing factor is the inconsistent coordination between a provider and an insurer when the insurer’s member is boarded in the ED while there is a search for available mental health or substance use disorder services.  In addition, many of the plans indicated that they are not aware when their members are being boarded and if the hospital is seeking assistance with the placement.

MHA, working closely with the Massachusetts Association of Health Plans, Blue Cross and Blue Shield of Massachusetts, and Beacon Health, developed and issued a document that contains an updated direct contact list for each of the plans operating in Massachusetts, as well as a chart showing the insurers’ notification or prior authorization requirements for inpatient admissions directly from the emergency department.

“Moving patients out of EDs efficiently requires the exchange of information between hospitals and health plans to ensure appropriate care coordination and placement of patients within inpatient or community base services, where appropriate,” said MHA’s VP of Legal and Regulatory Affairs Anuj Goel. “Our hope is that improving real-time communication between the parties will help with this continuing public health problem.” MHA will also be working with its members to track how this new process is working to determine other possible solutions.