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
- Certification of Medical Necessity for Waiver Assistive Devices form (PDF)
- Certification of Medical Necessity for Consumer-Directed Attendant Care form (PDF)
- Certification of Medical Necessity for Environmental Modification form (PDF)
- Certification of Medical Necessity for Home and Vehicle Modification form (PDF)
- Certification of Medical Necessity for Prevocational Services form (PDF)
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID) and Nursing Facilities PA and Concurrent Review Request Form (PDF)
How to submit prior authorization for LTSS
- Call AmeriHealth Caritas Iowa Utilization Management (UM) department at
1-844-411-0604, 8 a.m. to 5:00 p.m., Monday through Friday.
- Fax the appropriate completed form to LTSS Utilization Management fax at
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:
- Kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens.
- Bathtubs and toilets to accommodate transfer, special handles and hoses for shower heads, water faucet controls, and accessible showers and sink areas.
- Grab bars and handrails.
- Turnaround space adaptations.
- Ramps, lifts, and door, hall and window widening.
- Fire safety alarm equipment specific for disability.
- Voice-activated, sound-activated, light-activated, motion-activated, and electronic devices directly related to the member's disability.
- Vehicle lifts, driver-specific adaptations, remote-start systems, including such modifications already installed in a vehicle.
- Keyless entry systems.
- Automatic opening device for home or vehicle door.
- Special door and window locks.
- Specialized doorknobs and handles.
- Plexiglas replacement for glass windows.
- Modification of existing stairs to widen, lower, raise or enclose open stairs.
- Motion detectors.
- Low-pile carpeting or slip-resistant flooring.
- Telecommunications device for the deaf.
- Exterior hard-surface pathways.
- New door opening.
- Pocket doors.
- Installation or relocation of controls, outlets, switches.
- Air conditioning and air filtering if medically necessary.
- Heightening of existing garage door opening to accommodate modified van.
- Bath chairs.
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.