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Inpatient Services, Prior Authorization (PA) Submission Reminders & Short-Term Post Hospitalization Housing (STPHH)
Effective date
Sep 25, 2026
Identified
Sep 26, 2026
Summary
L.A. Care clarifies that routine vaginal and cesarean deliveries with standard postpartum stays (48-96 hours) do NOT require prior authorization, but any additional maternal or newborn services (NICU, complications, extended stays) DO require prior authorization with clear identification of the specific service and clinical diagnosis. Additionally, L.A. Care will stop accepting STPHH authorization requests after December 1, 2026, as this program sunsets effective January 1, 2027.
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What to do
Action · 12 steps
01REQUIREMENTS:
1. IMMEDIATE (By September 30, 2026): Billing team must update internal workflows and prior authorization submission processes:
- DO NOT submit prior authorization requests for routine vaginal deliveries (48 hours pre- and post-delivery) or routine cesarean deliveries (48 hours pre- and 96 hours post-delivery)
- Bill routine delivery claims directly without prior auth
- Update authorization checklist/forms to clearly identify routine vs. non-routine maternity services
- Train billing staff on the distinction between protected delivery stays and additional services requiring authorization
2.
02For ALL non-routine maternity/newborn inpatient services: Ensure prior authorization requests explicitly include:
- Specific service name and level of care (e.g., "NICU admission", "newborn phototherapy for hyperbilirubinemia", "maternal complications requiring extended hospitalization") — NOT generic terms like "vaginal delivery" or "C-section"
- Applicable diagnosis/clinical condition
- Whether service is for mother or newborn
- Date service/additional level of care began
- Supporting clinical documentation demonstrating medical necessity
- Correct CPT/HCPCS codes with frequency, duration, and units
- Use the Provider Prior Authorization Tool at https://www.lacare.org/node/53946 to route requests to correct entity (L.A.
03Care or Participating Physician Group)
3.
04By December 1, 2026: Billing team must STOP submitting new STPHH authorization requests to L.A.
05Care.
06Any STPHH authorizations requested after this date will not be accepted.
074. Before December 31, 2026: Identify all current patients with active STPHH authorizations approved before December 1, 2026.
08These will no longer be valid after December 31, 2026.
09Coordinate with case management and members on transition planning to revised Recuperative Care program when details become available.
10CONSEQUENCES: Incorrectly labeled authorization requests (e.g., submitting "C-section" when requesting NICU care) will cause processing delays or denials.
11Claims for non-routine services submitted without proper authorization will be denied.
12STPHH authorizations submitted after December 1 will be rejected.
Original notice
Inpatient Services, Prior Authorization (PA) Submission Reminders & Short-Term Post Hospitalization Housing (STPHH)
lacare.org · Always check the source before changing claims.