In accordance with Section 24 of Chapter 197 of the Acts of 2024 (the Long Term Care [LTC] Act), found at https://tinyurl.com/45rd4n99, payers are required to approved or deny, within one business day after receiving all necessary documentation, all requests for prior authorization (PA) for members who transfer from an inpatient acute-care hospital to a post-acute care facility or agency.
If MassHealth receives a complete PA request on a non-business day, when PA cannot be reviewed, PA may be waived under certain circumstances as a matter of law under the LTC Act.
Specific to home health services, the LTC Act requirements impact the PA request process for services for some MassHealth members who have had an inpatient acute-care hospitalization and are directly starting or resuming home health services.
See Home Health Agency Bulletin 93 to view the process for the expedited PAs and waiver of certain PA submission requirements for impacted members. The bulletin can be viewed at https://tinyurl.com/4v9fx5me.
If you have questions regarding this guidance, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.