Point32Health is making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
Our current Inpatient Hospital Admissions Payment Policy states that members who are readmitted to the same hospital within 30 days of the original inpatient discharge for the same or a related condition for which they were treated during the original admission may be reviewed. If it is determined that the member is being treated for the same or a related condition as the original admission, the readmission will be retracted.
For dates of service on or after June 1, this review will apply to members who are readmitted to the same hospital or the same hospital system within 30 days of the original inpatient discharge. This change in review process supports our goal of reducing avoidable readmissions and will apply for claims paid using diagnosis-related group or case rate payment methodology for all Point32Health products.
Refer to the updated policy for more information. In addition, we have updated our Readmission (Bridging of Claims) Payment Policy for Tufts Health Plan Senior Products to reflect this change.
(Consistent with Maine regulations, a redlined version of the Inpatient Hospital Admissions policy is posted temporarily.)