On November 25, 2020, the Centers for Medicare & Medicaid Services (CMS) gave hospitals facing another surge in COVID-19 patients more flexibility to care for Medicare patients outside of the walls of their hospitals. In March 2020, CMS announced the Hospitals Without Walls program, which allows hospitals to treat patients in various external locations, including dorm rooms and hotels, subject to certain conditions. The Acute Hospital Care At Home program expands on the Hospitals Without Walls program by allowing eligible patients who opt in to receive certain treatments in their own homes. According to a CMS press release, these programs include “allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers to provide greater inpatient care when needed.”

Six health systems were immediately granted waivers for the new Acute Hospital Care At Home program to treat more than 60 different conditions. CMS said it has been in discussion with other hospitals and expects new applications to be submitted. According to CMS, these acute conditions (which include asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease) can be treated appropriately and safely in home settings with proper monitoring and treatment protocols. This will free up additional space for hospitals to address the COVID-19 public health emergency. Patients may choose whether to receive these services in the home or the traditional hospital setting, and eligible patients who do not wish to receive them in their homes will not be required to.

The program distinguishes the delivery of acute hospital care at home from more traditional home health services. According to CMS, while home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis.

To take advantage of the regulatory flexibility created by these programs, interested hospitals must apply for a special waiver through an online portal created by CMS. Experienced hospitals participating in the hospital-at-home waiver program will be required to submit monitoring data on a monthly basis, while those without experience will be required to submit data on a weekly basis.