Home and Community Care Transitions

Middle-aged daughter and her mother look at something outside a sunny window

Point32Health has a partnership with Home and Community Care Transitions, who oversee utilization management review processes for skilled nursing facility (SNF), inpatient rehab facility (IRF)/acute inpatient rehab (AIR), and long-term acute care (LTAC) services, as well as home health care services. 

Optum uses the Medicare Benefit Policy Manual to perform utilization management reviews for these services. This review applies to Tufts Medicare Preferred members in Massachusetts unless they are included in a designated care management agreement with a professional medical group as indicated in this document. 

How the program works

Home and Community Care Transitions manages the prior authorization and concurrent/continued stay review processes in SNF, IRF/AIR, and LTAC settings. 

  • Providers can request authorization using Access (Home and Community Care Transitions’ online provider portal). Home and Community Care Transitions will then conduct the appropriate medical necessity review. 
  • In addition, providers must submit notification of their patients’ start of care (SOC) for home health care services to Home and Community Care Transitions within five days of the SOC. 
    • After the initial 30 days of home health treatment, prior authorization is required through Home and Community Care Transitions, who perform concurrent review, which includes clinical assessments for continued medical necessity.
  • Other processes managed by Home and Community Care Transitions include issuing and sending the Notice of Medicare Non-Coverage on behalf of Tufts Medicare Preferred patients and managing the Letter of Agreement process.

More information and resources

  • Using Tufts Health Plan’s secure online Provider Portal, providers can identify specific member requirements for post-acute care prior authorization and concurrent reviews.
  • In addition, Home and Community Care Transitions operates a resource platform known as Care Transitions Partner Hub, which offers clarity on documentation requirements for authorizations and continued stay reviews, contact details, information about the Tufts Medicare Preferred/Home and Community Care Transitions partnership, training materials, and more.