Home Care GAMP pays for authorized Registered Nurses and Physical Therapists in home visits for home bound patients. GAMP also pays for some durable medical equipment, IV therapy supplies and dressing supplies. A physician's order must accompany all new requests. Medical notes and additional information may also be requested by GAMP UR staff. All authorizations are time limited. The expiration date is accessible to providers in the GAMP Mcclears system.
Home Care Form: Include what services are to be provided, the frequency, and to whom.
DME Request Form: Please write out the diagnosis including the appropriate CPT code. If this is a new request, a physicians order needs to be faxed with this form to GAMP. Cost can be no higher than medicaid rates. |
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For nursing or physical therapy visits, complete "GAMP Home Care Authorization" . 
For dressing/IV supplies and DME items,complete "GAMP DME Request" . |
Hospital/Inpatient Rehab Admission
Preauthorized Hospital authorizations are required for all elective hospitalizations . The Provider will complete GAMP's "GAMP Community Clinic Referral Authorization" form, completing parts A and C, and fax the request for hospitalization with the supporting medical notes to GAMP UR. If no internet access is available, GAMP will fax the response to the provider. The hospital can obtain the authorization number and number of days authorized by accessing the GAMP Mcclears system. The Authorization number is good for 6 (six) months while the client remains GAMP eligible. As a reminder to all providers, please stay within the GAMP Hospital / Clinic affiliated network.
Hospitals are expected to provide GAMP with the patient's admission date, discharge date, or date of demise.
Urgent, Emergency, and Preauthorized Hospital Admissions are required to send GAMP the "GAMP Request for Admission/Continued Stay Authorization" form within 3 working days of the patient's hospital admission. GAMP will respond with an authorization number and authorized days if Severity and Intensity are completed on this form and indicate the patient has acute care needs. Any deviation from the norm shall be clarified in writing and faxed to the provider.
Inpatient Rehabilitation can be authorized by written request. This is accomplished on the "GAMP Request for admission/continued stay authorization" form. The patient must be capable of 3 hours of therapy per day. GAMP will issue an authorization upon receiving the following documents: OT, PT, and/or Speech evaluation; this may also include the discharge summary. For continued authorization of days of stay, the latest team conference report is required along with documentation. The patient continues to complete 3 hours of therapy a day. |
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For authorization for an Elective Admission, complete "GAMP Community Clinic Referral Authorization" . Please attach appropriate medical documentation to support your request when faxing to GAMP. For hospital admissions, complete "GAMP Request for Admission/Continued Stay Authorization" . If you need extra room for this form, click HERE . For authorization for Inpatient Rehabilitation, complete "GAMP Request for Admission/Continued Stay Authorization" . If you need extra room for this form, click HERE . |
Specialist Referral
The primary Clinic will complete parts A and B and fax the form "GAMP Community Clinic Referral Authorization" to GAMP UR along with supporting medical notes. The GAMP UR staff will respond within 3 (three) days of receiving the request for authorization. The Primary Clinic can access the authorization number after this time period on GAMP's website, which is valid for 6 (six) months while the client remains GAMP eligible. It is the Primary Care Clinic's responsibility to notify the specialist's office of this authorization and the services being authorized. Any deviation from the norm shall be clarified in writing and faxed to the provider requesting the authorization.
If the request for service is initiated by a specialist (who completes part A and C) then GAMP will fax the authorization to the fax number listed on part C of the form. Any deviation from the norm shall be clarified in writing and faxed to the provider requesting the authorization.
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For specialist referral, complete "GAMP Community Clinic Referral Authorization" . |
Procedure Referral
Generally this request for service comes directly from a specialist. Supporting medical notes and test results need to accompany the request. GAMP will fax the authorization number to the fax number listed on part C of the form. The GAMP UR staff will respond within 3 (three) days of receiving the request for authorization. The authorization can be accessed on GAMP's website after the three days. Any deviation from the norm shall be clarified in writing and faxed to the provider requesting the authorization. The authorization number is good for 6 (six) months while the client remains GAMP eligible.
As a reminder to all providers, please stay within the GAMP Hospital/Clinic affiliation network when making your requests.
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For procedural referral, complete "GAMP Community Clinic Referral Authorization" . |
Out-Patient Therapy
GAMP pays for physical therapy, occupational therapy, speech therapy, pulmonary rehab, and cardiac rehab on an out patient basis. The first visit for an evaluation is given after GAMP receives a completed "GAMP Community Clinic Referral Authorization" form.
Subsequent visit authorizations are made after the therapist completes a "Request for Therapy" form and faxes the form along with their evaluation to GAMP. The exception is cardiac rehab which has its own form.
In order to obtain additional physical therapy authorization
Once you have performed an initial physical therapy evaluation on a GAMP client, and you determine a plan of care, please submit the following for review and approval:
- Plan of Care
- Initial Evaluation
- Original GAMP Community Clinic Referral Authorization form with the T number (GAMP Therapy approval number)
- Completed GAMP PT/OT Request for Therapy form
If after completion of the authorized therapy sessions you feel it is necessary for the patient to have additional therapy visits, you will need to submit:
- Updated Evaluation and Plan of Care
- Original GAMP Community Clinic Referral Authorization form with the T number
- Original GAMP PT/OT Request for Therapy form with Part B completed
Submitting all of the above information will expedite the approval process.
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For obtaining additional physical therapy authorization, complete "GAMP Request for Therapy" . |
Cardiac Rehab
After getting authorization for an initial cardiac rehab evaluation, (done by completing "GAMP Community Clinic Referral Authorization" form) the therapist shall complete the "General Assistance Medical Program Request for Information Candidates for Comprehensive Cardiac Rehabilitation" form, and fax that form along with requested supporting information to GAMP. As a reminder to the evaluating therapist, please send the current list of medication, the EKG strip, target heart rate, and METS level.
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For an initial cardiac rehab evaluation, complete "GAMP Request For Information Candidates for Comprehensive Cardiac Rehabilitation" . |