Prior authorization changes coming Jan. 1, 2026

• 11/17/2025

On Jan. 1, 2026, Hennepin Health’s prior authorization (PA) requirements will change and an updated list outlining these requirements will be uploaded to Hennepin Health’s website. 

An overview of these changes include:

• Hennepin Health’s new review timeline:
  • Five business days for non-urgent authorization requests.
  • 48 hours including one business day for urgent authorization requests.
  • Within one business day upon receiving a Pre-Admission Screening (PAS) for SNBC. If additional information is needed from the referring facility, the PAS process will be completed within one business day of receipt of the additional information.
• All inpatient admissions require prior authorization on day 15.
• Chiropractic Care will be available only for members under the age of 21. Authorization required after 24 visits continues to be in place.

• Adding prior authorization requirements for Certified Family Specialist services and Certified Family Specialist Services in a group setting.
  
  • Authorization required after 300 hours.
• Removing the prior authorization requirement for medical supplies, prosthetics, and orthotics.
• Adding a list of durable medical equipment (DME) procedure codes requiring prior authorization.

• Adding prior authorization requirements for the following Rehabilitative and Therapeutic Services: 
  
  • Physical therapy – for more than 14 visits.
  • Occupational therapy – for more than 24 visits.
• Removing the prior authorization requirements for Housing Stabilization Services as this benefit was terminated by the Minnesota Department of Human Services (DHS).
• Updated the Skilled Nursing Facility process to no longer require prior authorization.
• Clinical supervision must be provided for EIDBI services and indicated in the ITP.  Providers must deliver 1 hour of clinical supervision by a Qualified Supervising Professional per 16 hours of direct treatment per person, unless an exception is authorized in the ITP.

Please reference Hennepin Health’s prior authorization page for the most up-to-date PA list.

Resources

• Hennepin Health Customer Services: 612-596-1036 (press 2)