Point32Health is making updates to our Medical Necessity Guidelines pertaining to home health care services, which vary by product and state. 

Effective Oct. 1, 2026, We’ve developed a new MNG specific to Tufts Health Together members. Subsequently, the current Home Health Care Services for Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care MNG will be updated to apply to Tufts Health RITogether and Tufts Health One Care only and will be renamed accordingly. 

The new Home Health Care Services for Tufts Health Together MNG will address prior authorization requirements for intermittent skilled nursing visits and medication assisted visits when services exceed 30 visits aggregate in a calendar year:

  • When requesting medication assisted visits, provide rationale to support the member/caregiver’s inability to administer medications independently. 
  • In addition, include the number of intermittent skilled nursing visits anticipated, supported by documentation of the member’s medical history and complexity of care, history of re-hospitalizations, history of frequent medication changes, and need for extensive observation and assessment. 

Prior authorization will no longer be required for HCPCS codes T1002 (RN Services, up to 15 minutes) and T1003 (LPN/LVN Services, up to 15 minutes).