Suspension of prior authorization for hospital-to-nursing facility 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; applies to Medicaid Managed Care Organizations (MCOs).
MCOs are suspending prior authorization requirements for clients transitioning from a hospital to a nursing facility effective December 31, 2021 through January 12, 2022, extended through February 18, 2022.
Coverage Criteria During Suspension
Temporary suspension criteria
Coverage stance during the suspension period:
Exceptions/Requirements
- PASRR (Pre-Admission Screening and Resident Review) requirement remains in effect and must be completed as applicable.
- There is no change to prior authorization requirements for behavioral health facilities; behavioral health admissions continue to follow existing prior authorization processes.
Provider Actions and Requirements
Suspend prior authorization for hospital-to-nursing transfers (Dec 31, 2021–Feb 18, 2022)
Medicaid MCOs must suspend prior authorization requirements for members transitioning from a hospital to a nursing facility for the temporary period effective December 31, 2021 through January 12, 2022, extended through February 18, 2022. This suspension is short-term and will be reevaluated by EOHHS.
- PASRR (Pre-Admission Screening and Resident Review) requirements remain in effect and must still be completed as applicable.
- There is no change to prior authorization requirements for behavioral health facilities; existing prior authorization processes for behavioral health admissions remain in place.
Definitions and Responsible Parties
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