Health Plans Continue To Reduce Prior Authorization Burden For Home Health Providers

Yet another payer organization is removing certain prior authorization requirements for home health care services.

Point32Health – the parent company of Harvard Pilgrim Health Care and Tufts Health Plan – announced Wednesday that it is removing prior authorization requirements for the first 30 days of home health care beginning on April 12.

The changes will affect members in Point32Health’s commercial plans.


“We continuously evaluate all our programs to ensure our members are receiving the highest quality of care and work closely with our provider partners to decrease their administrative burden wherever possible,” Dr. Hemant Hora, senior medical director at Point32Health, told Home Health Care News in an email. “We strive to offer a broad network of high-quality providers to our members. We welcome all home care providers interested in working with us to reach out.”

A nonprofit organization, Point32Health serves over 2 million members through a variety of health plans.

Formerly, home health services required prior authorization after initial evaluations from Harvard Pilgrim and Tufts Health Plan plans. That will no longer be the case, though prior authorization will still be required after the initial 30 days for a continuation of services.


Prior authorization requirements have long been one of the pain points for home health providers working with health plans outside of traditional Medicare.

“Care delayed is care denied,” Intrepid USA CEO John Kunysz told Home Health Care News recently, regarding prior authorization woes in home health care.

But there has been progress of late.

Last year, Cigna (NYSE: CI) shed a bevy of prior authorization requirements. Blue Cross Blue Shield of Massachusetts, too, eliminated prior authorization for home health discharges.

“We know from our clinical partners that local hospitals are experiencing a capacity crunch – we’re doing what we can to help,” BCBS of Massachusetts Chief Medical Officer Dr. Sandhya Rao told HHCN at the time. “By removing prior authorization requirements for home care services, we’ll help hospitals to expedite discharges at a time when many are struggling with overcrowding. This change will also reduce delays for Blue Cross members ready to transition their care from hospital to home.”

The changes will also likely improve the relationships between payers and home health providers.

“We hope that this will help expedite the delivery of home care services to members, especially those who are transitioning to home after a hospital or rehabilitation stay,” Hora said. “We will continue to monitor member utilization to ensure that the care that is delivered is both appropriate and high quality.”

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