Point32Health to eliminate prior authorizations for home health care services

New utilization management program aims to eliminate administrative burden on providers

Canton and Boston, Mass., April 2, 2024 — Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, announced today that it is updating its prior authorization requirements for home health care services for members in its commercial plans.¹ Beginning April 12, home care services will not require utilization management for the first 30 days after one of the company’s members is discharged from a hospital.

“We realize the administrative burden that prior authorization requirements can cause providers as well as our members. While prior authorizations are an important tool in helping us keep medical costs as low as possible and ensuring that our members receive high-quality care that is medically necessary, we do not want them to be an impediment,” said Glenn Pomerantz, MD, JD, chief medical officer, Point32Health. “This program is just the start of a larger review we are conducting as we seek new and innovative ways to partner more closely with provider community, while doing all we can to contain costs and make health care both more affordable and accessible.”

Currently, skilled services provided in the home (physical therapy, occupational therapy, and speech-language pathology services; social work visits; home health aides; skilled nursing; nutritional counseling) require prior authorization after the initial evaluation for Harvard Pilgrim and Tufts Health Plan plans. As of April 12, these services will instead require notification for the first 30 days of service — after the initial 30 days, prior authorization will be required for continuation of coverage.

“We anticipate that this change will improve turnaround times and better facilitate the coordination of care, getting members out of the hospital and back home sooner so they can begin their at-home treatment protocols,” added Dr. Pomerantz.

Providers interested in learning more can visit the provider section of the Point32Health website, or reach out to their account manager for more information.