Point32Health previously announced new prior authorization requirements to take effect on March 1, 2025 for Tufts Medicare Preferred members only, pertaining to skilled nursing facility care and long-term acute care.
After further consideration, we are amending this policy decision and the prior authorization requirement will only pertain to long-term acute care. The prior authorization requirement for skilled nursing facility care will not be applied for this member population at this time — we will continue to cover these services, when medically necessary, without prior authorization. The notification requirement and concurrent review process remain unchanged and will continue to be in effect.
In addition, prior authorization continues to be required for acute inpatient rehabilitation and non-emergent medical transportation for members of our Tufts Medicare Preferred and Tufts Health Plan Senior Care Options plans, as also announced in prior issues of Insights and Updates for Providers.
For more information, please refer to the Medicare Benefit Policy Manual and Point32Health’s prior authorization resources page.