During November 2020, in an effort to expand its Hospital Without Walls program, CMS granted hospitals the regulatory flexibility to provide eligible patients with acute care at home. Hospitals can enroll in CMS’s ‘Acute Hospital Care at Home’(HHC) program by filing waiver requests from Hospital Conditions of Participation criteria which otherwise require nursing services to be provided on site 24 hours a day, 7 days a week. Hospitals must also meet additional requirements to participate in the program. The additional requirements address protocols for at-home care, frequency of patient evaluation, patient data review, and patient safety metrics. The program allows hospitals to receive Medicare fee-for-service reimbursements for home-based services provided to eligible patients.
Research on pre-existing hospital-at-home programs suggests that the model reduces costs. Those costs are normally associated with the provision of care, reducing readmissions, reducing mortality rates, and supporting patient recovery. However, pre-pandemic, hospital-at-home programs were largely unavailable due to challenges hospitals faced in receiving reimbursement from CMS and other payors for at-home services. The current HHS program wherein CMS waivers qualify services for reimbursement, has garnered a significant amount of interest from providers around the country. As of January 2021, 96 hospitals in 26 states have enrolled in the program.
While CMS installed the program as a response to COVID-19 surges, program benefits may be applied beyond the current public health emergency. Hospital participants, especially those that may supplement the program with Home Health capabilities, are hopeful that the program is here to stay. As a result, CMS and private payors are demonstrating interest in continuing to provide reimbursement for hospital-at-home services post-pandemic.
While the program is popular with both providers and payers uncertainty persists around whether CMS will extend the waivers beyond the current public health emergency. Although, recent communications with regional CMS offices have alluded to keeping this program post-COVID, CMS has not issued any notices or proposed guidance regarding its extension. Stay tuned for further updates as Advis monitors guidance from CMS regarding the program’s extension.
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Published: February 9, 2021