We’re pleased to announce that we have partnered with Home and Community Care Transitions to enhance the management of post-acute care benefits for Tufts Medicare Preferred members in Massachusetts. (Please note that members included in a designated care management agreement with a professional medical group as indicated in this document are excluded from this program.) 

Starting April 1, 2026, providers who serve these members will need to submit authorizations for post-acute care to Home and Community Care Transitions, who will oversee associated utilization management review processes and work closely with providers to optimize care delivery and improve patient outcomes. 

This review applies to 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. Home and Community Care Transitions will leverage their expertise in population health and long-term care management to work collaboratively with post-acute care providers and their patients in accessing quality care in the setting that’s right for them.

Processes to be managed by Home and Community Care Transitions 

For applicable members, Home and Community Care Transitions will manage 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, and they will conduct the appropriate medical necessity review. 

Keep in mind that current approved authorizations for SNF, LTAC, and IRF/AIR admissions (obtained directly through Tufts Health Plan) will continue to be valid and a new authorization isn’t required in these instances.

In addition, providers will need to submit notification of their patients’ start of care (SOC) for home health care services to Home and Community Care Transitions. After the initial 30 days of home health treatment, prior authorization will be required through Home and Community Care Transitions, who will perform concurrent review, which includes clinical assessments for continued medical necessity. 

Other processes shifting to 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. 

Information and transactions available on our respective provider portals

In advance of the April 1 effective date, Tufts Health Plan’s secure online Provider Portal will be enabled with a tool to identify specific member requirements for post-acute care prior authorization and concurrent reviews. 

Home and Community Care Transitions has also developed a new 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.