News

Effective November 30, 2022: Clinical Policies

Date: 09/21/22

Superior HealthPlan has updated certain clinical policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on November 30, 2022, at 12:00AM.

POLICY	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Gender-Affirming Procedures (CP.MP.95)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter	Policy updates include: Added note before the criteria section stating that individuals with a disorder of sexual development (i.e. intersex) don’t need to meet all the same criteria for duration of gender dysphoria, age requirements and duration of prior treatment such as hormone therapy Incorporated gender-neutral language to the eligibility and criteria section II. A. 1, E. and III. A and B In II.B., noted that informed consent includes awareness of treatment effects on fertility Added the word “minimum” to degree requirement in criteria II.F. and G In II.E, noted that the requirement of 12 months of hormone therapy before mastectomy in adolescents should be considered on a case-by-case basis. Added new criteria in section IV regarding facial procedures Modified the not medically necessary procedures list in VI accordingly

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Gender-Affirming Procedures

(CP.MP.95)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

Added note before the criteria section stating that individuals with a disorder of sexual development (i.e. intersex) don’t need to meet all the same criteria for duration of gender dysphoria, age requirements and duration of prior treatment such as hormone therapy
Incorporated gender-neutral language to the eligibility and criteria section II. A. 1, E. and III. A and B
In II.B., noted that informed consent includes awareness of treatment effects on fertility
Added the word “minimum” to degree requirement in criteria II.F. and G
In II.E, noted that the requirement of 12 months of hormone therapy before mastectomy in adolescents should be considered on a case-by-case basis.
Added new criteria in section IV regarding facial procedures
Modified the not medically necessary procedures list in VI accordingly

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.