Prior Authorization Requirements for Therapy Services

This guide outlines the prior authorization (PA) requirements for outpatient therapy and home health care services provided to Medicaid members by Molina Healthcare of Illinois. It specifies that a separate PA is necessary for each type of outpatient therapy—Physical, Occupational, and Speech—after an evaluation and twelve visits within the calendar year. For home health care, PA is required after an evaluation and six visits. The document details that no PA is needed for the evaluation and the initial visits for in-network providers. It emphasizes the importance of submitting specific diagnosis codes and clinical information with PA requests to ensure timely review. Additionally, it provides guidelines on the turnaround time for requests and clarifies what constitutes an urgent request. The memo also includes contact information for provider support and highlights the transition to the Availity Essentials Portal for claims management.