Prior Authorization for Discharges From Acute to Sub-Acute Facilities

For members of our Massachusetts, Rhode Island, and Connecticut products, Point32Health (the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan) has voluntarily agreed to waive prior authorization for from acute care hospitals to sub-acute facilities for a period of 90 days. Facilities should notify Point32Health within 24 hours of the admission. Point32Health will continue to perform concurrent reviews to determine the appropriateness of level of care. This decision was made in response to requests from state regulators and local hospitals to address capacity concerns currently straining the delivery system. This temporary waiver takes effect as follows and applies to members of all Harvard Pilgrim Health Care and Tufts Health Plan products offered in these states:

• For Massachusetts members: effective from Dec. 6, 2022 – March 6, 2023
• For Rhode Island members: effective from Dec. 9, 2022 – March 9, 2023
• For Connecticut members: effective from Dec. 12, 2022 – March 12, 2023