Temporary Suspension of Prior Authorizations for New Nursing Home Admissions Being Directly Discharged from a Hospital
Due to the COVID-19 Public Health Emergency (PHE) and to expedite a hospital’s ability to discharge patients to lower levels of care when medically appropriate, the prior authorization (PA) waiver for medically necessary new admissions who are being directly discharged from a hospital setting into a nursing home (NH) is extended to Oct. 31, 2021.
The PA waiver applies to members receiving services under both NC Medicaid Direct and the Standard Plans. Standard Plans are permitted to require notification within three calendar days of skilled nursing facility admissions to facilitate care management and transitions to other care settings as clinically appropriate.
If the individual is expected to remain in the nursing facility past Oct. 31, 2021, the admitting nursing facility is responsible for verifying long-term care Medicaid eligibility with the local Department of Social Services (DSS) and following the prior approval requirements noted in NH Clinical Policy 2B-1. The date on the FL2 form for NC Medicaid Direct beneficiaries should be the NH admission date. All claims are subject to audit.
Extension of Temporary Suspension of Prior Authorization for Inpatient Rehabilitation Hospital and Long-Term Care Hospital Admissions under Managed Care
Due to the COVID-19 PHE, and to expedite a hospital’s ability to discharge patients to lower levels of care when medically appropriate, the prior authorization waiver for medically necessary Inpatient Rehabilitation and Long-Term Care Hospital admissions is extended to Oct. 31, 2021.
Standard Plans are permitted to require notification of Inpatient Rehabilitation and Long-Term Care Hospital admissions within three calendar days of admission to those facilities, in order to facilitate care management and appropriate transitions of care to alternative care settings as clinically appropriate.
The prior authorization waiver also applies to transfers from acute inpatient hospitals to same levels of care, if necessary, to manage COVID-19 surge levels. Standard Plans are permitted to require notification of acute-to-acute facility transfers within three calendar days of transfer/admission. All claims are subject to audit.
Note: Under NC Medicaid Direct, a prior approval is not currently required for an acute inpatient hospital or long-term care hospital admission.
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