News

Clinical Policy: Short Inpatient Hospital Stay - Effective September 15, 2020

Date: 08/14/20

Superior HealthPlan has introduced a new clinical policy to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policy has been added:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Short Inpatient Hospital Stay (CP.MP.182)	Effective September 15, 2020	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP, Allwell (HMO and HMO SNP) and Ambetter	It is the policy of Superior HealthPlan that inpatient hospital stays (vs. observation) of 48 hours or less are medically necessary for one of the following indications: Admission for a procedure on the CMS Inpatient only list Admission to an intermediate or ICU level of care Unexpected death during the admission Departure AMA from a medically necessary inpatient stay Transfer from another facility with a medically necessary total length of stay greater than 48 hours Election of hospice care in lieu of continued treatment in hospital

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Short Inpatient Hospital Stay (CP.MP.182)

Effective September 15, 2020

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

It is the policy of Superior HealthPlan that inpatient hospital stays (vs. observation) of 48 hours or less are medically necessary for one of the following indications:

Admission for a procedure on the CMS Inpatient only list
Admission to an intermediate or ICU level of care
Unexpected death during the admission
Departure AMA from a medically necessary inpatient stay
Transfer from another facility with a medically necessary total length of stay greater than 48 hours
Election of hospice care in lieu of continued treatment in hospital

To review all Clinical policies, please visit Superior’s Clinical and Payment Polices webpage.

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

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