Back to Insights and Updates for ProvidersFebruary 2024

Prior authorization for SNF care for Tufts Health Plan SCO

Tufts Health Plan Senior Care Options

Point32Health wants to make our provider network aware of a change regarding requirements related to skilled nursing facility (SNF) care, which will take effect on April 1, 2024.

For members with our Tufts Health Plan Senior Care Options product, prior authorization will be required for SNF care. Additionally, inpatient notification will continue to be required upon admission to a SNF.

As you may be aware, and as outlined in this article also published in this issue of Insights and Updates for Providers, Point32Health is waiving prior authorization requirements from Jan. 9, 2024 until April 1, 2024 for admissions from acute care hospitals to Massachusetts (MA) sub-acute care facilities and rehabilitation facilities for all applicable Harvard Pilgrim Health Care and Tufts Health Plan products. The implementation of this prior authorization requirement for SNF care for Tufts Health Plan Senior Care Options members will occur concurrently with the end of the temporary MA prior authorization waiver.

For more information, please refer to the Tufts Health Plan Senior Care Options (SCO) Prior Authorization List and Senior Care Options Notification List.

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