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Provider Quick Tips #246: Rescinding Prior Guidance on Elective Services

Issued: May 7, 2020

On March 26, 2020, the Office of Medical Assistance Programs (OMAP) issued a provider quick tip that elective services should not be provided during the COVID-19 emergency disaster and described the manner in which requests for authorization of elective services would be reviewed. This guidance was based on Governor Wolf’s and Secretary of Health Dr. Rachel Levine’s executive orders which prohibit elective medical and surgical procedures from being performed in Pennsylvania during the duration of the COVID-19 emergency. 

On April 27, 2020, the Department of Health (DOH) issued updated guidance for hospitals and ambulatory surgical facilities regarding elective procedures. Based on the updated guidance from DOH, the Office of Medical Assistance Programs (OMAP) rescinds the guidance on elective services issued on March 26, 2020. 

As of April 27, 2020, Medical Assistance (MA) Fee-for-Service authorization requests for inpatient and outpatient elective procedures, elective interventional radiology and dental procedures will be reviewed and authorizations issued if the service is medically necessary. Prior authorization changes outlined in Quick Tip #241 remain in effect. 

All procedures reviewed from March 26-April 27, 2020 that were determined to be elective and were approved other than as requested with a start date of July 1, 2020, will be changed to reflect an effective date of April 27, 2020. Updated notices will be sent to the provider, recipient and prescriber indicating the new effective begin date of the elective procedure. 

Additional guidance will be issued for CHIP and the MA managed care programs. 

Providers should continue to check the Department of Human Service’s COVID-19 website and the Department of Health’s website for updates. 

For elective inpatient, outpatient and radiology authorization questions, please contact 1-800-537- 8862, option 2, option 3, option 1. 

For dental questions regarding this information please contact 1-800-537-8862, option 2, option 6, option 1.