Learn more about new federal Medicaid changes.
Hennepin Health made updates to prior authorization (PA) requirements starting July 1, 2026. Read below for a summary of these updates.
1. Extension of Standard Authorization Timeline
The standard prior authorization determination timeline may be extended by up to 14 additional days when permitted by regulation and when additional clinical information is needed to complete the review.
2. Inpatient Admission Review Requirement
All inpatient admissions will now require prior authorization beginning on day 16 of the inpatient stay.
3. PA requirements have been added for the following service categories:
- Electrical Stimulation Devices
- High Frequency Chest Wall Oscillation Systems
- Wheelchair Accessories and Wheelchair Repairs
- Blood Glucose Monitors and Continued Blood Glucose Monitors
- Robotic Arms and Assistive Technology
- One hour of clinical supervision by a Qualified Supervising Professional is required for every 16 hours of direct treatment.
- Clinical documentation must include any previously delivered services or visits when applicable.
- Rehabilitation requests must include dates of service for prior services delivered within the calendar year.
4. Removal of Prior Authorization Requirements
PA requirements for BRCA genetic testing services are being removed.
5. Updates to Dollar Thresholds
Dollar thresholds have been adjusted for the following items:
Children’s Residential Facility treatment for individuals ages 20 and under.
7. Updates to Substance Use Disorder Benefit Limits
Any combination of individual counseling/psychoeducation and group counseling/psychoeducation - daily limit of 6 hours (24 units) or 30 hours (120 units). Peer Recovery Support - daily limit of 2 hours (8 units) per day or 14 hours per week (56 units).
Policy Criteria Updates
Our UM program continues to use InterQual® and DHS criteria in determining medical necessity. In addition, internal HH UM Medical Policies support consistent review processes, including:
Providers are encouraged to review the updated PA list and UM medical necessity policies prior to submitting authorization requests.
Resources: