SHPBN-2017-021 Nursing Facility Prior Authorization Changes

Date: 06/05/17

Authorization Requirements for Nursing Facility Providers

Effective May 15, 2017, prior authorization requirements for Long Term Care Nursing Facility services will change.

• Skilled Care Nursing Facility Services  – Prior authorization will be required.  
  • Ventilator, Head Injury Rehabilitation, etc.
• Custodial Care Nursing Facility Services – Prior authorization will no longer be required.

The removal of prior authorization for custodial NF stays does not change requirements related to assessments or documents submitted for the purpose of eligibility determination or to meet other requirements outlined in KMAP, provider manuals, or directed by KDADs.

Long Term Care Nursing Facility Services

Long Term Care Nursing Facility Services are billed with a type of bill of 21X and the appropriate room and board revenue code.

If you have questions about this bulletin or other provider resources, please contact our Customer Service Center at 1-877-644-4623.