Skip to Main Content

Important Inpatient Hospital Stay Update

Date: 08/28/20

Update Regarding Medically Necessary Requirements for Short Inpatient Hospital Stay for Ambetter and Allwell from Sunflower Health Plan

In accordance with Clinical Policy CP.MP.182, effective October 1, 2020, inpatient hospital stays (vs. observation) of two days or less are medically necessary for one of the following indications:

  • Admission is for a procedure on the CMS Inpatient Only List (ZIP);
  • Admission to an intermediate or intensive care unit level of care (including neonatal intensive care unit (NICU) considered medically necessary per a nationally recognized clinical decision support tool;
  • Unexpected death during the admission;
  • Departure against medical advice from a medically necessary (per a nationally recognized clinical decision support tool) inpatient stay;
  • Transferred from another facility, with a medically necessary (per a nationally recognized clinical decision support tool) total length of stay greater than two days;
  • Election of hospice care in lieu of continued treatment in hospital.

All inpatient hospitalizations require prior authorizations. 

Questions about prior authorizations? Please see our prior authorization checker.

If you have questions about this bulletin, please contact Customer Service at 1-855-565-9519 (HMO), 1-833-402-6707 HMO D-SNP or TTY 711.