Point32Health routinely evaluates our utilization management and transition of care processes and requirements to ensure that our members are receiving care in the most appropriate treatment setting and at the most appropriate level of care.
To that end, we’re aligning our authorization practices concerning medically necessary observation stays across all products. Currently, in certain cases observation stays may be authorized for longer than 48 hours for members of our Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care plans. Effective Aug. 1, 2025, however, we will no longer authorize observation stays longer than 48 hours for these members, as is currently the policy for members of our other Harvard Pilgrim Health Care and Tufts Health Plan products.
We’ve updated our Inpatient Acute and Post-Acute Levels of Care (Medical/Surgical) Medical Necessity Guidelines as well as our Observation Stay Payment Policy to reflect this change.