Temporary Changes to Medicaid Prior Authorization Requirements

Date: 09/08/21

To help support increased access to care during the COVID-19 pandemic, effective August 20, 2021, Trillium Community Health Plan has temporarily waived the prior authorization requirements for the services listed below for our Trillium Medicaid members:

• The prior authorization requirement for SNF admission has been waived for Trillium Medicaid members.
• All authorizations for elective inpatient procedures and all outpatient services will be approved with a six-month window for Trillium Medicaid members.
• The prior authorization requirement for Home Health (HH) Services has been waived for Trillium Medicaid members.
• The prior authorization requirement for Durable Medical Equipment (DME) has been waived for products with a billed amount $500.00 and under for Trillium Medicaid members. This is regardless of funding on the Prioritized List.
• Regardless of formulary status, pharmacy discharge prescriptions for Trillium Medicaid members will be approved for one fill via a call from the discharge planner or the retail pharmacy.    

Through December 31, 2021, for Trillium clients with medical benefits, Trillium will automatically approve discharge to inpatient rehabilitation units and LTAC hospitals if the prior authorization request shows that:

• The billing and rendering providers are Medicaid-enrolled, and
• The client has current Trillium eligibility.

We will continue to work in close partnership with state, local and federal health authorities to best serve our communities during this pandemic, and provide you with updates as the situation changes.  

Thank you for your partnership in helping our members stay healthy. If you have questions regarding the information contained in this update, please contact Trillium Medicaid Provider Services at 1-877-600-5472.