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UnitedHealthcare’s New Policy is a Win for Long-Term Care and Senior Living Facilities and Patients

HUNT VALLEY, MD – January 9, 2025 – In a major development for senior living facilities and long-term care providers, UnitedHealthcare (UHC) has announced updates to their Prior Authorization policy that could significantly improve the access to care and overall experience for their patients. Starting January 13, 2025 UHC will cover up to 6 visits of a member’s initial care plan without conducting a clinical review when the 6 visits take place with the first 8 weeks of the initial care plan for many outpatient therapy services for Medicare Advantage (MA) members.

Here are key take-aways from the news:

PAs often involve delays, extra paperwork, and follow-up, leading to disruptions in care delivery. With the removal of this step, our rehabilitation providers will now have smoother workflows, enabling them to dedicate more time to direct patient care.
There will be less need for administrative time and effort, and potential cost savings.
Ease of access to necessary therapy services can be reassuring for patients.
While There is no change to the current clinical submission process providers must continue to submit a prior authorization request for the entire plan of care, including the full duration and number of visits requested (including the automatic 6 visits). So, there would be no need to hold treatment. If you are requesting more than 6 visits the care plan will be assessed for medical necessity- Timely physical or occupational therapy interventions can prevent complications like falls, loss of independence, or deterioration in mobility.

UnitedHealthcare’s move to cover visits prior to an authorization for outpatient therapy services represents a positive significant step forward for long-term care and senior living facilities. With quicker access to services, streamlined processes, improved patient outcomes, and greater satisfaction for both providers and patients, this policy change is a win on many levels.

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