Prior Authorization Requirements
New Authorization Structure for Claims billed
on Dates-of-Service Effective 5/1/2026
Authorization Requirements for PACE (Program of All-inclusive Care for the Elderly), Family Care Partnership, and Family Care Program
To understand what services (Medical and Long-term Care) require authorization, please review each of the following documents separately for each program:
Family Care Partnership
***Partnership has had many changes, especially in the NEW Pre-Service Authorization* requirements***
- FCP Bariatric and Transplant Surgery Prior Authorization Request Form
- FCP Genetic Testing and Molecular Pathology Prior Authorization Request Form
- FCP Hospice Prior Authorization Medicaid Only Form
- FCP Other Medical Services Prior Authorization Request Form
- FCP Physician Administered Medication Prior Authorization Request Form
- FCP Post-Acute Facility Prior Authorization Request Form
- FCP Post-Acute Facility Continued Stay Review Form
- FCP SPECT & PET Imaging Prior Authorization Request Form
- FCP Surgery Prior Authorization Request Form
*Pre-Service Authorizations which require contact with the interdisciplinary Team Staff (IDTS) are not prior authorizations. They instead require the IDTS to complete the Resource Allocation Decision (RAD) process with the member/Legal Decision Maker prior to any services/supports being provided. If the IDTS contacts are unknown, call 1-866-992-6600 to be connected to the appropriate IDTS.
PACE (Program of All-Inclusive Care for the Elderly)
- PACE Bariatric and Transplant Surgery Prior Authorization Request Form
- PACE Genetic Testing and Molecular Pathology Prior Authorization Request Form
- PACE Other Medical Services Prior Authorization Request Form
- PACE Physician Administered Medication Prior Authorization Request Form
- PACE Post-Acute Facility Prior Authorization Request From
- PACE Post-Acute Facility Continued Stay Review Form
- PACE SPECT & PET Imaging Prior Authorization Request From
Family Care Program
For Providers billing from 6-1-25 through 4-30-26, please use the previous Prior Authorization Requirement document.
