UPDATED: COVID-19 Update: Extension of Prior Authorization for Some Acute Care Services
Pursuant to continued guidance received from Texas Health and Human Services (HHS), Superior HealthPlan is issuing an extension for prior-approved acute care service authorizations with an end date between August 1, 2020 and December 31, 2020.* A 90-day 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 extended authorization will be at the same frequency and amount of the initially-approved authorization for the applicable service, and no action is required from providers to prompt the extension of the authorized timeframe for the relevant prior authorizations. Superior is in the process of updating the applicable authorizations. Providers will receive notice of the updated authorization documenting the extended timeframe, and can also access Superior's Secure Provider Portal to confirm authorization status. Until that documentation is received, Superior encourages providers to continue the provision of the medically necessary services listed above to ensure continuity of care for Superior members.
Providers should utilize medical judgment on the appropriateness and medical necessity of the extension of services for each member, 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 extension is not applicable to new prior authorization requests. Request for initial authorization of service, received on August 1, 2020 and after, 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.
*Please note: Previously, the end date for this guidance was April 30, 2020, then extended to May 31, June 30, July 31, October 23 and November 30, 2020. Per HHS, guidance dates have been extended through December 31, 2020, unless the U.S. Secretary of Health and Human Services ends the public health emergency earlier. If the public health emergency ends earlier, HHS will provide additional information.