TEMPORARY SUSPENSION OF PRIOR AUTHORIZATIONS FOR POST-ACUTE PLACEMENTS

The NC Medicaid program has announced a temporary suspension of prior authorizations (PA) for new nursing home admissions who are 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 requirement for new admissions, who are being directly discharged from a hospital setting into a nursing home (NH), is waived for Medicaid beneficiaries between September 1 – 30, 2021.  The PA waiver applies to members receiving services under both NC Medicaid Direct and the Standard plans.

If the individual is expected to remain in the nursing facility past September 30, 2021, the admitting nursing facility is responsible for verifying long-term care Medicaid eligibility with the local DSS and following the prior approval requirements noted in NH Clinical Policy 2B-1. The date on the FL2 form or the Standard Plan’s authorization form, as applicable, should be the NH admission date. All claims are subject to audit.