Below is an
email we sent out on 3.5.25 regarding updates to the Medicaid PA program.
We hope all is
well! We are emailing to let you know about some important updates regarding
Medicaid PA that came out recently. FSSA is still considering what and how
specifically they will implement these changes to stay within the state
regulations already in place. In other words, there are a lot of moving
parts still to be resolved but this is our understanding of the changes at the
moment. Please also note that although some of these proposed changes are new
to you, they are not new to the Medicaid PA process. For example, the
work letter requirement was previously in place for several years until
recently.
As you (or your
client) enter the 60 day window prior to your (their) renewal you will receive
a notification similar to below outlining what is needed from you (client) for
the Medicaid PA renewal. Those individuals who are 60 days or less out as of
today will receive their notification in addition to this email.
Below is a
comprehensive list of the documentation required for prior authorization (PA)
requests for home health services under Indiana Medicaid, as outlined in the
IHCP bulletin dated February 20, 2025. Please ensure that the following items
are submitted to the office prior to the expiration of your current Prior
Authorization in order to continue utilizing services during the renewal
period:
- Parent/caregiver work calendars with employment letters (on letterhead with days and times working and signed by employer).
- Member school calendars.
- Information on all other supportive services and therapies the member is
receiving, including but not limited to:
- Medicaid waiver services such as Structured Family
Caregiving and Attendant Care hours.
- Skilled nursing hours, physical or occupational therapy
- Other shift/hour services such as applied behavior
analysis (ABA) therapy.
- If the agency staff providing home health services are also the parent or
legally responsible individual for the member.
- Physician face-to-face medical necessity attestation required for ongoing
home health services within the previous 30 days of the request for a new
authorization or expiration of the current authorization. You must have a
face-to-face visit with the physician 30 days prior to your new prior
authorization start date.
These
requirements are in addition to the current guidelines listed in the Home
Health PA Documentation section of the Home Health Services provider reference
module.
If you have any
questions or need further clarification, please reach out to us at 317-575-3983
or submit a ticket to us at
support@comforcare.zohodesk.com.
Thank you for
your attention to this matter.
The ComForCare
Home Care Team