Short Inpatient Hospital Stay

This policy covers medically necessary short inpatient hospital stays (including observation services, Acute Hospital Care at Home, ICU/NICU admissions, transfers, hospice election, and admissions for CMS/InterQual inpatient‑only procedures) for members of non‑Medicare Centene‑affiliated plans, with adult CMS inpatient‑only rules applying to ≥18 and InterQual pediatric inpatient‑only designations for <18. Coverage requires documentation of medical necessity—typically supported by a nationally recognized clinical decision support tool—limits outpatient observation generally to ≤48 hours, excludes behavioral health and obstetrical delivery admissions, requires hospital participation and in‑person physician evaluation/daily physician rounding for Hospital‑at‑Home, and is subject to CMS inpatient‑only designations and member benefit terms.

"Short inpatient hospital stays of less than three midnights that are medically necessary for ongoing short-term treatment, assessment, and reassessment to determine whether inpatient admission is r..."