Respite authorization renewals

HealthKeepers, Inc. would like to remind long-term services and supports (LTSS) care providers of the benefits of the Commonwealth Coordinated Care Waiver regarding respite hours.

Prior to the start of the 2024 to 2025 fiscal year, HealthKeepers, Inc. will automatically renew any existing respite authorizations for all active members for the new fiscal year, July 2024 through June 2025. We ask that care providers please refrain from submitting respite authorization renewals for the new fiscal year as this will be managed internally on an annual basis. Submitting respite renewal requests create a large influx and duplicate efforts for both the care providers and our staff, resulting in potential delays for standard general fax requests.

HealthKeepers, Inc. asks that the DMAS 97 A/B for respite is only submitted upon initial start of respite services and as a part of the authorization documentation sent alongside the renewal of the Personal Care/Attendant Care services. Also, if a member transitioned to a new care provider prior to July 1, and respite hours have been exhausted prior to June 30 (with their previous care provider), the new care provider is responsible for initiating a new respite authorization request for new fiscal year.

In addition, LTSS care providers are expected to continue to notify HealthKeepers, Inc. promptly of any changes to member eligibility, member respite benefits, or changes among providers, including when splitting services with other providers, whether agency-directed or consumer-directed.

As a reminder, care providers are responsible for tracking the hours that a member receives during the fiscal year. If a member changes care providers in a fiscal year — whether it is from agency-directed to consumer-directed or agency-to-agency — the new care provider should obtain this information from the previous care provider to ensure total hours do not exceed 480. When requesting a respite authorization, it should only be for the remaining hours left in the fiscal year, not the total 480 hours benefit.

There will not be any mailed or faxed approval notices for auto-renewed respite authorizations. Care providers may view authorization details using the following online resources: Provider 360, Availity Essentials, Public Partnerships, LLC website (PPL), and Netsmart.

Please verify your members respite authorizations using the resources above. If you identify missing respite authorizations after June 9, 2024, please compile a spreadsheet of all members (including member name and member ID number) and submit via secure email to ltssmmsqa@anthem.com to notify us of authorization(s) needed.

If you have any questions about this communication, contact Anthem HealthKeepers Plus Provider Services at 800-901-0020.

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