Prior Authorizations Suspension for Hospital-to-Nursing Transfers
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Temporary suspension of Medicaid managed care prior authorization requirements for members transitioning from hospitals to nursing facilities in Rhode Island, affecting Rhode Island Medicaid Managed Care Organizations (MCOs) and applicable discharges during the suspension period.
Effective December 31, 2021–January 14, 2022, MCOs are suspending prior authorization requirements for clients transitioning from a hospital to a nursing facility.
Coverage Criteria During Suspension
Temporary suspension criteria
Operational criteria during suspension period:
Temporary suspension to streamline hospital discharges and improve hospital capacity during the COVID-19 pandemic; suspension is short term and will be reevaluated by EOHHS prior to January 14, 2022.
Exclusions and maintained requirements
Exclusions and continuations:
Provider Actions and Operational Notice
Suspend prior authorization for hospital-to-nursing transfers (temporary)
Effective December 31, 2021 through January 14, 2022, suspend prior authorization requirements for Medicaid MCO members transitioning from a hospital to a nursing facility to streamline hospital discharges and improve hospital capacity during the COVID-19 pandemic. Do not change prior authorization requirements for behavioral health facilities; PASSR requirements remain in effect. The suspension is short-term and will be reevaluated by EOHHS prior to January 14, 2022 for potential extension.
- Suspension period: December 31, 2021–January 14, 2022.
- Scope: applies to hospital-to-nursing facility transfers for Rhode Island Medicaid MCO members.
- Exclusions: no change to prior authorization requirements for behavioral health facilities.
- Continued requirements: PASSR remains in effect.
- Review: suspension is short-term and will be reevaluated by EOHHS prior to January 14, 2022.
Key Definitions
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