District court rules AHA can file amicus brief in case challenging Aetna’s ‘level of severity’ policy

The U.S. District Court for the Eastern District of Pennsylvania Aug. 5 granted a motion for the AHA and the Hospital and Healthsystem Association of Pennsylvania to file an amicus brief submitted in June in support of Jefferson Health’s challenge to Aetna’s “level of severity” reimbursement policy. The policy is a reimbursement for “low severity” inpatient stays that Aetna said will be “comparable” to observation rates. Aetna moved to have Jefferson Health’s case decided in arbitration rather than federal court litigation. 

Aetna also moved to exclude the AHA’s amicus brief. The court today rejected that motion and recognized the value of the AHA’s filing. “If the Policy directly affects AHA and HAP member hospitals, particularly by creating administrative and financial burdens, then Movants may properly take a special interest in the litigation’s outcome,” Judge John M. Gallagher wrote. “Their role as national trade associations strengthens, rather than weakens, that interest. These organizations represent stakeholders across the healthcare industry and are positioned to absorb and respond to operational hardships arising from the Policy’s enforcement. … The record also reflects that AHA has spent years working with members to ensure Medicare Advantage Organizations comply with the Two-Midnight Rule.”