COVID-19 Disaster Declaration – ALERT #4 – Prior Authorization Adjustments

Attention: All Provider Notice
Effective Date: April 13, 2020

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action:

As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following changes to our authorization procedures. This alert is an update to our alert on April 2, 2020 and expands the prior-authorization extension beyond long-term services and supports (LTSS) based on direction from the Texas Health and Human Services Commission:

• Prior authorizations for services that require recertification and are set to expire March 1, 2020 through May 31, 2020 will be extended an additional 90 days. The extended authorizations will contain the same proportional amount and frequency as was authorized in the original authorization. There is no action required from the provider as the automatic extensions are in process.

• This extension does not apply to current authorizations for one-time services, new requests for authorization, or pharmacy prior authorizations. For example, a single non-emergency ambulance trip would not be extended, but a recurring non-emergency ambulance authorization for dialysis would be extended.

• This extension applies to all state plan services requiring recertification, including acute care and long-term services and supports such as personal assistance services, personal care services, community first choice, private duty nursing, physical, occupational and speech therapies, durable medical equipment(DME) and day activity and health services for example.

• Retrospective Prior Authorization requests – In order to increase access to services and supplies, TCHP may accept prior authorization (PA) requests submitted within seven (7) calendar days of the requested service start date and the request will not be considered retrospective.

Requests will still be subject to TCHP medical necessity determination from the start date of service.

How this impacts providers:

• This means that for services or supplies requiring PA, TCHP will review the request as timely so long as the request is received within seven (7) calendar days of the requested start date of the service. Requests meeting this criteria will not be considered as retrospective.

• For LTSS, private duty nursing (PDN), therapy, and durable medical equipment (DME) services, TCHP may waive the “change of provider” letter requirements and approve changes of a previously approved or authorized provider at the provider/member request without formal documentation. Providers/members should state “Need to Change Provider, COVID-19” in the request.

• We will temporarily waive hearing screen and well-child requirements for therapy approvals for services that start during the COVID-19 State of Disaster Declaration or for extension requests that are requested during this time.

Previous posting link(s):

• http://www.thecheckup.org/2020/03/19/provider-alert-covid-19-disaster-declaration-prior-authorization-adjustments/
• http://www.thecheckup.org/2020/04/02/provider-alert-covid-19-disaster-declaration-alert-2-prior-authorization-adjustments/
  
• http://www.thecheckup.org/2020/04/07/provider-alert-covid-19-disaster-declaration-alert-3-prior-authorization-adjustments/

Texas Health and Human Services Advisory Notice Information:

Reporting COVID-19 – Provider, Provider Staff and Provider’s Patients

Effective immediately per the Texas Health and Human Services Commission, a provider must report every presumptive and confirmed case of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident. A presumptive or confirmed case is considered a critical incident. Providers (other than HCS and TxHmL providers) must notify HHSC through TULIP or by calling Complaint and Incident Intake (CII) at 1-800-458-9858. Home Community Services (HCS) and Texas Home Living (TxHmL) waivers program providers must notify HHSC at: waiversurvey.certification@hhsc.state.tx.us.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.