Aetna Delays Implementation of Harmful Payment Policy, CHA Continues Push for Withdrawal

After hospital and healthcare leaders across the country voiced opposition to Aetna’s new Level of Severity Inpatient Payment Policy, the commercial health insurance company has announced it is delaying the effective date from November 15, 2025, to January 1, 2026.  In the notice issued Thursday, November 6, Aetna also outlined amendments to the original policy, including:

• Level of severity review will apply only to urgent/emergent inpatient stays of at least one midnight but less than five midnights
• Stays of five midnights or greater will not be subject to level of severity review and will be paid at the inpatient diagnosis-related group (DRG) rate
• For inpatient stays of at least one midnight but less than five midnights that do not meet Milliman Care Guidelines (MCG) criteria, providers may request a severity review and engage in a severity discussion with an Aetna medical director

The Connecticut Hospital Association (CHA) is urging Aetna to rescind the new payment policy promptly, stressing its implementation could increase financial strain and impose unnecessary administrative burden on Connecticut hospitals.

In a comment letter submitted to Aetna last month, and shared with the Connecticut Insurance Department, CHA articulated concerns that the policy undermines regulatory safeguards designed to uphold physician judgment, protect beneficiary coverage, and encourage program transparency.  This week, in a written response to CHA’s comments, Aetna reiterated the delayed implementation date and policy modifications made as a result of providers’ feedback.

CHA maintains that the Level of Severity Inpatient Payment Policy deviates from the longstanding medical necessity review and denial processes by automatically approving certain claims at a lower rate of reimbursement, effectively eliminating the opportunity for hospitals to request a peer-to-peer or concurrent review before admission or while a patient is receiving treatment in a facility to ensure appropriate payment for the care provided. 

CHA continues to monitor this issue and will provide additional information as it becomes available.

Click here for CHA’s previous coverage of Aetna’s new payment policy.

Click here to read CHA’s October letter to Aetna.

Click here to read Aetna’s November response to CHA.