Medicare AdvantageCoverageMedium impact
Inpatient and Long Term Acute Care Hospital Services - Medicare Advantage (Revised)
Humana·Medicare Advantage
Effective date
Nov 3, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised its Medicare Advantage policy for inpatient and long-term acute care hospital services, effective November 3, 2025. The policy clarifies coverage determination criteria using MCG guidelines for inpatient admissions, dental-related hospitalizations, and LTCH/LTACH services, emphasizing the two-midnight rule and medical necessity requirements.
Action Required
Before November 3, 2025: Review current inpatient admission documentation practices to ensure compliance with MCG guidelines and two-midnight rule criteria. Update prior authorization workflows for LTCH/LTACH admissions to align with MCG medical necessity standards. Train clinical staff on enhanced documentation requirements for dental-related inpatient admissions to demonstrate underlying medical conditions or procedure severity.