American Hospital Association urges Aetna to rescind new MA inpatient payment policy

Fierce Healthcare – Tuesday, September 16, 2025
By Heather Landi

Aetna, owned by CVS Health, plans to implement a new Medicare Advantage (MA) inpatient payment policy that changes how urgent and emergent inpatient claims are paid.

Beginning Nov. 15, the insurer will implement a “level of severity inpatient payment” reimbursement approach under which emergency and urgent inpatient admissions of more than one midnight will be automatically approved.

But if the patient does not meet inpatient criteria according to Milliman Care Guidelines (MCG) inpatient criteria, Aetna will only reimburse the hospital at the rate for observation services, which is a reduced rate.

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