We want to share an update on how we process authorization requests for outpatient home care and hospice and palliative care services — for members of Harvard Pilgrim Health Care fully insured Commercial products in Maine only. There is no change for providers. Please continue to make authorization requests as you do today.

For Harvard Pilgrim Commercial members, authorization is needed for outpatient hospice and palliative care, as well as for home health care services after the initial notification period of 30 days. This will continue to be the case; utilization management requirements and medical necessity criteria for home health care and hospice services are not changing.

However, for Maine members, requests for ongoing hospice and home health care services (beyond the initial set of visits) will be classified as concurrent reviews and processed under concurrent review timeframes, consistent with guidance from the Maine Bureau of Insurance. 

For Commercial members who are not in Maine plans, all requests for outpatient home health and hospice and palliative services will continue to be treated as prior authorization reviews. 

For more information, please refer to the Home Health Care Services and Hospice and Palliative Care Services Medical Necessity Guidelines.