Aetna has postponed the rollout of its new “level of severity inpatient payment” policy for Medicare Advantage members, moving it from Nov. 15 to early next year. Under this approach, Aetna will automatically approve certain inpatient stays—without a medical necessity review—but pay them at a lower severity rate similar to observation status unless the stay meets Aetna’s additional inpatient criteria.
The policy applies to affiliated Medicare facilities and focuses on urgent or emergent admissions lasting at least one midnight but fewer than five.
- Stays within that timeframe will undergo the severity review.
- Stays five midnights or longer will be paid at the full inpatient DRG rate.
- If a stay doesn’t meet Aetna’s time-based or supplemental inpatient guidelines, providers may request a medical director review.
All other policy elements remain unchanged.
The delay comes after concerns raised by the American Hospital Association, which warned the policy could distort Medicare Advantage Star Ratings and complicate dispute resolution for hospitals.