Summary of New CMS Flexibilities for Acute Hospital Care at Home Program

The Centers for Medicare & Medicaid Services (CMS) Nov. 25 announced several flexibilities aimed at allowing health care services to be provided outside of a hospital setting in response to the surging COVID-19 pandemic.

Specifically, as urged by the AHA, CMS expanded on its Hospitals Without Walls program by introducing the Acute Hospital Care At Home program. CMS created Hospitals Without Walls in March to provide regulatory flexibility for hospitals to treat patients in locations outside the hospital, including their homes. The agency has now created the Acute Care Hospital At Home program to provide additional regulatory flexibility for hospitals to treat patients requiring acute inpatient admission in locations outside the hospital, including their homes. This program requires an in-person physician evaluation and screening protocols to assess medical and non-medical factors before a patient can begin receiving care at home. Beneficiaries may be admitted to the program only from emergency departments and inpatient hospital beds. A registered nurse must evaluate each patient once daily in person or remotely, and either registered nurses or mobile integrated health paramedics must conduct two in-person visits daily based on the patient’s nursing plan and hospital policies. Hospitals also will be required to report quality and safety data to CMS at a frequency based on their prior experience with providing acute hospital care at home.

As part of this announcement, CMS also approved waivers for six health systems with extensive experience providing acute hospital care at home that will now begin immediately participating in the new program. These include: Brigham and Women’s Hospital and Massachusetts General Hospital in Massachusetts; Huntsman Cancer Institute in Utah; Mount Sinai Health System in New York; Presbyterian Healthcare Services in New Mexico; and UnityPoint Health in Iowa.

To apply for a waiver request to participate in the program, hospitals should visit CMS’ online portal, available here. CMS will divide the waiver requests into two categories based on hospitals’ prior experience and will require a more detailed request for hospitals which have treated fewer than 25 patients with acute hospital services at home. CMS’ frequently asked questions (FAQs) on the Acute Hospital Care at Home program are available here.

AHA’s The Value Initiative has several resources on hospitals-at-home, including a webinar with two of the health systems chosen for initial participation. Watch for additional case studies and issue briefs on hospital-at-home from The Value Initiative.

In related news, CMS clarified that ambulatory surgical centers (ASCs) participating in the Hospital Without Walls program need only provide 24-hour nursing services when they have one or more patients receiving care onsite. FAQs for ASCs are available here.

Further Questions

If you have questions, please contact AHA at 800-424-4301.