Medicaid Connecticut – Reinstatement of Prior Authorization Requirements

Executive Order (EO) 7EE, Section 4 is set to expire as of April 20, 2021 thereby eliminating the Department of Social Services’ (DSS) authority to waive or modify existing prior authorization (PA) requirements. As such, EFFECTIVE for dates of service April 20, 2021 and forward, CMAP enrolled providers MUST obtain PA or PA thresholds are being revised for the following services:

• In-state and Border Inpatient Hospital Admissions

• Inpatient hospice days greater than 5 days

• Outpatient Behavioral Health Services

• Advanced Radiology and Imaging Services

• Home Health Services (thresholds returning to the standard levels see 17b-262-732 of the Regulations of Connecticut State Agencies)

• Dental (Endodontic) Services

• Medical Equipment, Devices and Supplies (requests for reauthorization must include all complete paperwork)

Source: https://www.ctdssmap.com/CTPortal/Information/Get Download File/tabid/44/Default.aspx?Filename=Reinstate_PA_Requirements.pdf&URI=Important_Message/Reinstate_PA_Requirements.pdf