Home Health Care Prior Authorization Change

Tufts Health Direct

October 01, 2021  

Effective for dates of service on or after January 1, 2022, Tufts Health Plan will require prior authorization for home health care requests following the initial evaluation for skilled nursing, and/or a physical therapy home care assessment/evaluation visit for Tufts Health Direct. Speech therapy, occupational therapy and/or social work visits will require prior authorization for the initial evaluation when provided independently and not in conjunction with physical therapy or skilled nursing visits. Prior authorization requests for all home health care disciplines for Tufts Health Direct must be submitted to Tufts Health Plan within two business days of the start of care. Note: This change will align with the prior authorization requirements for home health care services for all Commercial products.

Tufts Health Direct did not previously require prior authorization unless services were provided daily or until the member had been receiving home health care services for six months and required continued services.

Note: Tufts Health RITogether, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) and Tufts Health Unify will continue to follow their existing prior authorization requirements for home health care services. For more information, refer to the Medical Necessity Guidelines for Home Health Care Services for Tufts Health Together, Tufts Health RITogether and Tufts Health Unify.