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Long-Term Services and Supports (LTSS) Prior Authorizations

LTSS providers require prior authorization from AmeriHealth Caritas Delaware. All LTSS services should be requested through the LTSS case managers.  Only those services covered by the respective waivers can be requested.

  • All unlisted and miscellaneous codes
  • All HCBS Habilitation program services
  • All services not listed on the AmeriHealth Caritas Delaware Fee Schedule

The Plan’s LTSS Personal Care Connector Team’s department hours of operation are 8 a.m. to 5 p.m. ET, Monday through Friday. The Care Connectors can be reached at:

  • UM LTSS Case Manager Telephone: 1-855-260-9544.
  • UM LTSS Fax:  1-855-843-1177.

For prior authorizations after hours, weekends, and holidays, call Member Services at 1-855-349-6281.

How to submit prior authorization for LTSS

By phone

  • Call AmeriHealth Caritas Delaware Utilization Management (UM) department at
    1-855-260-9544, 8 a.m. to 5 p.m., Monday through Friday.

By fax

  • Fax the appropriate completed form to LTSS Utilization Management fax at
    1-855-843-1177.

LTSS services requiring prior authorization

  • For enrollees residing in their own homes or in an LTSS facility: LTSS will be authorized or re-authorized during the face-to-face, on-going care management intervention
  • Adult day health care services: authorization is required after 1st visit and re-evaluated as needed based authorizations provided or based upon medical necessity.
  • Personal emergency response system and home-delivered meals: prior authorization is required. A care coordinator will re-evaluate and provide further authorization as needed.
  • Home modifications, vehicle modifications, or non-ambulation assistive devices: clinical evaluation of the home or vehicle is required initially by care coordinator, 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.

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 and necessary materials have been received.