Washington, DC: Post-acute care management update

To align with new federal Medicare-Medicaid integration rules, starting Jan. 1, 2027, Home and Community Care Transitions will begin utilization management for all Dual Special Needs Plans in Washington, D.C. Previously, UnitedHealthcare managed this process. This is not a new utilization management requirement.

Affected plans

The following plans are the only ones that will be affected by this change in these markets:

• Washington D.C. Dual Special Needs Plans (DSNP):
  • H2406-053-000
  • H2406-099-000
  • H7464-010-000

The process for all other plans in these markets will remain the same.

Prior authorization details

For active prior authorization requests for post-acute inpatient services before Jan. 1, 2027, no action is needed from you. UnitedHealthcare will close these requests, and Care Transitions will open them under the new DSNP policy on Jan. 1, 2027. Also, starting Jan. 1, 2027, prior authorization requests can be submitted through the Access portal. 

This includes prior authorization and concurrent review, as well as discharge planning, for the following post-acute levels of care:

• Skilled nursing facilities 
• Acute inpatient rehab 
• Long-term acute care 

You can access educational and training materials for Access and other processes can be found on the Partner Hub.

Questions? We’re here to help.

If you have questions, contact your assigned Care Transitions provider relations manager.