Tags Posts tagged with "Prior Authorization"

Prior Authorization

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RCPA has received notification from PA Health & Wellness (PHW) regarding an update to the prior authorization process for Residential and Structured Day Habilitation services. The updates included in the notice are effective starting August 1, 2023.

Questions regarding this update should be directed to PHW’s Provider Services at 844-626-6813 or to Provider Relations via email.

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Image by Dirk Wouters from Pixabay

In today’s Federal Register, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that included updates to the Medicare Advantage program. Contained within this proposed rule is a Request for Information (RFI): Prior Authorization for Hospital Transfers to Post-Acute Care (PAC) Settings During a Public Health Emergency (PHE). The RFI highlights several concerns, including the fact that providers often wait up to three days for authorization determinations, and that a high rate of MA requests are initially denied, all of which hinder the ability of hospitals to maximize capacity during a public health emergency (PHE). The RFI requests several areas for feedback, including the overall impact of prior authorization on hospitals and patient care, the denial rates and associated burden on providers, and the consequences of delayed patient transfers.

Members are encouraged to share any direct examples of these prior authorization issues with Melissa Dehoff, Director, Rehabilitation Services Division. In addition, this issue will be discussed during the upcoming Outpatient Rehabilitation Committee and Medical Rehabilitation Committee meetings.