We're updating our related readmissions policy on April 27

As we continually seek ways to ensure our members receive the right care at the right place at the right time, we’re revising our related readmissions policy. The updates outlined below, which align with industry standards, are effective on Apr. 27, 2023.

What’s changing?

We’re making the following policy changes to update what will be considered a related readmission and denied additional coverage:

Current state	Future state
Member discharged (a) before all medical treatment is rendered or (b) without an adequate discharge plan or (c) where care during the second admission could have occurred during the first admission	Member discharged (a) before all medical treatment is rendered or (b) without an adequate discharge plan or (c) where care during the second admission could have occurred during the first admission or (d) failed discharge plan
Member discharged from the hospital after surgery but readmitted within 30 days with a direct or related complication from the surgery	Member discharged from the hospital but readmitted within 30 days with a direct or related complication from the first admission
Member discharged from the hospital with a documented plan to readmit within 30 days for additional services	Member discharged from the hospital with a documented plan to readmit within 30 days for additional services, excluding chemotherapy or staged surgical procedures
Member requires re-admission due to a recurrence of the same condition – two-allowable payments	Member requires re-admission due to a recurrence of the same condition

What's not changing?

• Readmissions determined to be related are denied and considered part of the original admission.
• The facility may appeal the readmission denial.
• If the readmission would have been paid at a higher rate than the first, the facility can pursue adjusted reimbursement.