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Announcements
Temporary Administrative Approvals for PDN PARs Through Dec. 31, 2022
This message is for members who receive Private Duty Nursing (PDN) benefits, and their families. The Department heard concerns regarding the PDN Prior Authorization Request (PAR) process. Our shared goal is to ensure Colorado has programs that provide people with access to the services they need, which is especially important for those with complex healthcare needs. We continuously evaluate how to best balance our responsibility to ensure our members have timely access to care and our federal responsibility to demonstrate all authorized services are medically necessary at the level approved. We take your feedback seriously.
We are reaching out to you to let you know the Department is initiating a Temporary Administrative Approval Process (through Dec. 31, 2022) on all PDN PARs. This means that if you received a full or partial denial for Private Duty Nursing services it will be approved as requested until Dec. 31, 2022. Any new PARs will also be approved through Dec. 31, 2022. This will give us time to work with your providers so they can submit all the needed documentation to ensure the right level of care is approved in a timely manner. You do not need to take any action; however, during this time your provider will be required to submit PARs and all supporting documentation. Your provider may reach out to you for additional information or documentation from your physician. We will be sending formal notices with this information over the coming weeks.
We also heard feedback that our notices can be confusing. In response, we will be working to improve those notices over the coming months. We will also be working on additional educational materials to help you understand what to expect in the prior authorization process, your appeal rights, the option to continue services during an appeal, and what benefits may be available.
This Temporary Administrative Approval process will allow us time to conduct outreach to families, work with our providers to ensure they understand prior authorization, documentation, as well as continuation of benefits requirements, and update our notices to ensure greater clarity.
If you have questions about the PDN benefit or the prior authorization process, you may reach out to the Department at homehealth@state.co.us.
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