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COVID-19 Update: Extension of Prior Authorization for Some Acute Care Services

Date: 04/07/20

Note: Please view UPDATED: COVID-19 Update: Extension of Prior Authorization for Some Acute Care Services for an updated end date for this guidance.

Pursuant to guidance received from Texas Health and Human Services (HHS), Superior HealthPlan is issuing a 90-day extension for prior-approved acute care service authorizations with an end date between March 1, 2020 and May 31, 2020. Authorization extension is being issued for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members that require ongoing receipt of applicable services, equipment and supplies to ensure continuity of care, as listed below:

  • Durable Medical Equipment (DME) rental
  • Physical, Occupational and Speech Therapy (PT, OT, ST) treatment
  • Private Duty Nursing (PDN)
  • Recurring Clinician Administered Drugs (CAD)
  • Recurring medical supplies
  • Recurring non-emergent transportation
  • Skilled nursing visits

The modified authorization will be at the same frequency and amount of the prior-approved authorization, and no action is required from providers to prompt the extension of the authorized timeframe for the relevant prior authorizations. Superior estimates completion of the extension for applicable authorizations within the next 30 days. Providers will receive notice of the updated authorization documenting the extended timeframe, and can also access the Secure Provider Portal to confirm authorization status.

Providers should utilize medical judgment on the appropriateness and medical necessity of the extension of services for each member/patient, and are encouraged to submit an amended request for continued authorization of services, as necessary. In addition, providers must maintain clinical documentation (i.e., expanded physician order) to support ongoing provision of service, in the member’s file. The authorization extensions may be subject to retrospective review.

The 90-day extension is not applicable to new prior authorization requests received March 1, 2020 through May 31, 2020. Those requests will be reviewed utilizing existing prior authorization requirements and protocols for processing, review and determination of medical necessity.

Please call Superior’s Prior Authorization Department at 1-800-218-7508 with any questions.