MedicaidPrior AuthMedium impact
[Ohio] Home Health Services & Private Duty Nursing Services for Greater than 60-Days
CareSource·OH · Palliative Care, Geriatrics, Pediatrics·Specialty Services
Effective date
Jul 1, 2024
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid/MyCare clarifies that private duty nursing and home health services are NOT subject to a hard 60-day authorization limit. Providers may now request authorization periods exceeding 60 days for members with chronic conditions, with approval based on individualized medical necessity and health status per OAC rule 5160-26-03.1.
Action Required
By January 8, 2026: Billing and prior authorization teams must update internal policies and authorization request templates to reflect that CareSource no longer enforces a 60-day hard cap on private duty nursing and home health services for Ohio Medicaid/MyCare members. Providers should document specific medical necessity, member health status (chronic/stable/debilitating conditions), and Healthchek coverage status when requesting authorizations beyond 60 days. Update authorization denial protocols to ensure claims are not rejected solely based on exceeding 60-day thresholds. Train staff to reference OAC rule 5160-26-03.1 when responding to authorization inquiries. Contact CareSource Provider Services at 1-800-488-0134 with questions.