MedicaidPrior AuthMedium impact
[Ohio] Temporary Waiver of Prior Authorization Requirements for Nursing Home Admissions from Hospital
CareSource·OH · Geriatrics, Critical Care, Internal Medicine·Provider Bulletin
Effective date
Feb 24, 2025
We identified it
May 9, 2026
Summary
CareSource is temporarily waiving prior authorization requirements for nursing home admissions from hospitals in Ohio through March 9, 2025, due to high influenza-related hospitalizations. Nursing homes must notify CareSource within three calendar days of admission with member demographics, clinical information, and PASRR documentation. CareSource will approve the first three days and initiate continued stay review using submitted clinical information.
Action Required
By March 9, 2025: Billing team must suspend prior authorization requirement enforcement for nursing home admissions from hospital discharges for affected CareSource plans in Ohio. Coordinate with nursing home discharge planners to ensure admissions are reported to CareSource within three calendar days with required documentation (member demographics, admission date, clinical information, and PASRR evidence or Hospital Exemption Notice). Update internal workflows and communication templates to reflect the temporary waiver. After March 9, 2025, revert to standard prior authorization procedures for nursing home admissions. Document all waivers applied for audit purposes.