Post-Acute Care Guidelines

Post-acute care and home health services require prior authorization and are evaluated for medical necessity using MCG™ evidence-based care guidelines (effective 1/1/2021) and other evidence-based tools, with the Medicare Benefit Policy Manual applied only for Medicare members. The excerpt specifies no explicit covered diagnoses, exclusions, frequency limits, age restrictions, or documentation requirements beyond adherence to those referenced source guidelines.

"Post-Acute Care Prior Authorization Criteria includes, but not limited to: MCG™ evidence-based care guidelines® - effective 1/1/2021"

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