New Prior Authorization Requirement Not for SNFs or HHAs

August 21, 2024

BY Nicole Fallon

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New prior authorization policy for United Healthcare/Optum Medicare Advantage plans related to outpatient therapies does not apply to skilled nursing facilities or home health agencies.

United Healthcare (UHC) and Optum notified providers in August that beginning September 1, 2024, it would begin requiring prior authorization for outpatient therapies-physical therapy (PT), occupational therapy (OT), speech therapy (ST)-and chiropractic care in most of its Medicare Advantage (MA) plans.

However, while this policy applies to PT, OT, and ST, it only applies to "multidisciplinary offices and outpatient hospital settings." It does NOT impact our skilled nursing facilities (SNF) or home health agencies (HHAs). The memo explains the new policy only impacts the following settings:

• 11 Office
• 19 Off-Campus Outpatient Hospital
• 22 On-Campus Outpatient Hospital
• 24 Ambulatory Surgical Center
• 49 Independent Clinic
• 62 Comprehensive Outpatient Rehabilitation Facility

SNFs and HHAs should note that while there is no new requirement, existing prior authorization requirements remain for these providers. In other words, to the degree that these providers already must seek prior authorizations, those policies continue.

For more details about this new prior authorization policy on outpatient therapy, check out these resources direct from the source:

• August 1, 2024 UHC notice on new prior authorization requirement for outpatient therapy and chiropractic
• Prior Authorization changes for outpatient therapy services, includes FAQs