Change in Non-Routine Therapy Prior Authorization Requirements for Medicaid Beneficiaries Residing in a Nursing Facility (SNF)

The Michigan Department of Health and Human Services (MDHHS) recently released the following bulletin, MMP 23-45, announcing a change in non-routine therapy prior authorization requirements for Medicaid beneficiaries residing in a nursing facility. Effective August 1, MDHHS will remove the Prior Authorization (PA) requirement for non-routine therapy services provided to Medicaid beneficiaries residing in a skilled nursing facility within 60 days of their admission to the facility.

Non-routine therapies refer to the occupational therapy (OT), physical therapy (PT), and speech therapy (ST) services that are covered separately from the per diem rate. Providers must obtain PA for any non-routine therapy services provided after the initial 60-day post-admission period. This includes new episodes of therapy or continuations of therapy already in progress. PA is required for all therapy provided after day 60 regardless of the amount of therapy performed during the admission period. Re-authorizations are required every 60 days.

This change only applies to new admissions to a nursing facility. Subsequent emergency or planned hospitalizations do not impact the requirements for PA. A copy of the physician prescription or documented clearance to resume therapy must be retained in the beneficiary’s medical record.

MDHHS will also change the prescription signature requirements for non-routine therapy services rendered to Medicaid beneficiaries residing in a skilled nursing facility to align with outpatient and private practice therapy signature requirements. This change will expand the pool of providers who can sign the non-routine therapy prescription for a nursing facility resident from a physician only to a physician or other licensed practitioner practicing within their scope of practice as defined in state law for occupational therapy, physical therapy, and speech-language therapy.

Direct any questions regarding this change to Provider Inquiry, Department of Health and Human Services, P.O. Box 30731, Lansing, Michigan 48909-8231, or email [email protected]. Be sure to include your name, affiliation, NPI number, and phone number. Providers may also call toll-free (800) 292-2550.