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Long-Term Services and Supports (LTSS) Prior Authorizations

Long-term services and support (LTSS) and consumer-directed attendant care (CDAC) providers require prior authorization from AmeriHealth Caritas Iowa.

For enrollees residing in their own home
LTSS will be authorized or re-authorized every 90-days during the face-to-face, on-going care management intervention.

For enrollees residing in an LTSS facility

Unless otherwise noted, all LTSS will be authorized or re-authorized every 120 days during the face-to-face on-going care management intervention.

LTSS and CDAC prior authorization forms

How to submit prior authorization for LTSS

By phone

  • Call AmeriHealth Caritas Iowa Utilization Management (UM) department at
    1-844-411-0604, 8 a.m. to 5:00 p.m., Monday through Friday.

By fax

  • Fax the appropriate completed form to LTSS Utilization Management fax at
    1-844-399-0479.

LTSS services requiring prior authorization

  • For enrollees residing in their own home: LTSS will be authorized/re-authorized every 90-days during the face-to-face on-going care management intervention.
  • For enrollees residing in a LTSS Facility (NF, NFMI, ICF/ID, MHID, SNF): Unless otherwise noted, all LTSS will be authorized/re-authorized every 120-days during the face-to-face on-going care management intervention.
  • Adult day health care services: authorization required after 1st visit and re-evaluate every 6 months.
  • Nursing care, non-skilled: authorization for 25 visits in 60 days. Needs re-authorization every 60 days.
  • Homemaker services, for duties listed above: authorization required after the 1st visit and re-evaluate every 90-days.
  • Personal emergency response system: prior authorization required. Care coordinator to re-evaluate every 6 months.
  • Home delivered meals: prior authorization required. Care coordinator to re-evaluate every 6 months.
  • Home modifications, vehicle modification or non-ambulation assistive devices: clinical evaluation of the home or vehicle is required initially by care coordinator or occupational therapist or physical therapist. Prior authorization for equipment is required. A prescription will need to be written by the PCP to supply to the DME provider. This includes: 
  1. Kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens.
  2. Bathtubs and toilets to accommodate transfer, special handles and hoses for shower heads, water faucet controls, and accessible showers and sink areas.
  3. Grab bars and handrails.
  4. Turnaround space adaptations.
  5. Ramps, lifts, and door, hall and window widening.
  6. Fire safety alarm equipment specific for disability.
  7. Voice-activated, sound-activated, light-activated, motion-activated, and electronic devices directly related to the member's disability.
  8. Vehicle lifts, driver-specific adaptations, remote-start systems, including such modifications already installed in a vehicle.
  9. Keyless entry systems.
  10. Automatic opening device for home or vehicle door.
  11. Special door and window locks.
  12. Specialized doorknobs and handles.
  13. Plexiglas replacement for glass windows.
  14. Modification of existing stairs to widen, lower, raise or enclose open stairs.
  15. Motion detectors.
  16. Low-pile carpeting or slip-resistant flooring.
  17. Telecommunications device for the deaf.
  18. Exterior hard-surface pathways.
  19. New door opening.
  20. Pocket doors.
  21. Installation or relocation of controls, outlets, switches.
  22. Air conditioning and air filtering if medically necessary.
  23. Heightening of existing garage door opening to accommodate modified van.
  24. Bath chairs.

Installation

If a member needs a DME item that requires installation, the care coordinator will help the member review their options and select only qualified providers.

Prior authorization decisions will be made once all requested/necessary materials have been received.