Private Duty Nursing and Pediatric Long-Term Home Health Services Pre-Approval Project

The Department of Health Care Policy & Financing previously notified Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing Providers that the Prior Authorization Request (PAR) requirement for these services would be suspended as of July 1, 2020. After considerable evaluation, stakeholder engagement, and internal discussion, the Department has determined to keep the PAR requirement suspended through winter 2020/2021 and will resume the submission of PLTHH and PDN PARs to the UM Vendor no earlier than March 1, 2021. Upon restarting the PARs for these benefits, the Department will provide timely communication to members, Providers and other stakeholders to allow for planning and preparation purposes. The resumption of the PAR requirement for these services will involve a phased-in implementation and the Department will collaborate with Providers to develop the plan for each phase of PAR submissions.

As previously communicated, Providers can, and should, continue to provide medically necessary services in compliance with Department rules at 10 CCR 2505-10, Sections 8.520 and 8.540. If the services are medically necessary and in compliance with rules and regulations, Providers can submit the claims to the Department’s fiscal agent, Gainwell Technologies.   

Additional information about the future resumption of PLTHH and PDN PARs will be shared with  Providers via Gainwell Technologies, posted on the Department’s Project website, and on the ColoradoPAR program website. If there are additional questions, concerns or specific issues regarding these PARs please email the Department’s UM Team at hcpf_UM@state.co.us and email questions regarding policy to the Department’s Benefits team at hcpf_benefitsupport@state.co.us.  

Please Note: This PAR suspension does not affect Long Term Home Health PARs for Adults (members aged 21 and over) and for any issues regarding Adult Long Term Home Health, Providers should contact the appropriate Case Management Agency or hcpf_lthhPARs@state.co.us.

For Members:
Action Needed: None Currently 
If you currently have private duty nursing services, pediatric long-term home health services, or both, you will receive a letter with more information.

For Providers: 
Action Needed: Providers need to ensure their User Administrator is set up with eQSuites, so they receive timely communication regarding PDN/PLTHH PAR submission in progress when those updates start coming out.
If you currently treat members who receive private duty nursing services, pediatric long-term home health services, or both, you will need to submit an updated plan of care and supporting documentation in the new request. Details on this process can be found here

Trainings:

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