September 18, 2001

Managed Care Organizations, Insurance Law Article 43 Corporations and Insurers Licensed to Write Accident and Health Insurance

            In the days since the catastrophe, it has become increasingly clear that limited or interrupted telephone and fax service, diversion of medical staff for disaster preparedness, evacuation of offices in lower Manhattan, disruption to mass transit systems and staffing constraints have impacted the normal business of managed care organizations, Article 43 corporations and insurers licensed to write accident and health insurance (hereinafter "health plans").

            The Department of Health and the Insurance Department are jointly asking that health plans take whatever actions are necessary to simplify administrative practices and procedures during this difficult time. Plans that have their operations located in New York City and/or that cover persons in New York City should examine their utilization review policies and procedures in light of these tragic circumstances. Utilization review policies and procedures include those used by the health plans and any of their subcontractors related to notification requirements following emergency services, preauthorization of non-emergency services, concurrent review and discharge planning.

            Each health plan should submit a description of how its operations were impacted by this disaster and the modifications that the plan and its subcontractors have made to utilization review procedures during this period to the contact persons listed below no later than October 2, 2001. Health plans that have received this letter but who do not have their operations based in New York City, cover New York City residents or whose health insurance policies do not involve utilization review procedures should acknowledge receipt of the letter and indicate why it is not applicable to them.

To the New York State Department of Health: Ms. Vallencia Lloyd, Director Bureau of Certification and Surveillance Room 1911. Corning Tower Empire State Plaza Albany, New York 12237 To the New York State Insurance Department: Deborah A. Kozemko Health Bureau New York State Insurance Department Agency Building One Empire State Plaza Albany, New York 12257 Or by e-mail to dkozemko@ins.state.ny.us

Kathleen Shure, Director
Office of Managed Care
New York State Department of Health

Thomas Zyra, Co-Chief
Health Bureau
New York State Insurance Department