CMS Expands Flexibilities Under Hospital Without Walls Initiative

King & Spalding

Last week, CMS announced additional flexibilities that expand its Hospital Without Walls initiative, which provides broad regulatory flexibility that allows hospitals to provide services in locations beyond their existing walls. These changes include providing safe hospital care for eligible patients in their homes, updated staffing flexibility for ambulatory surgical centers (ASCs), and expanded Medicare telehealth coverage. These actions allow healthcare services to be provided outside a hospital setting while maintaining the capacity to continue critical non-COVID-19 care.

Acute Hospital Care at Home Program

Last week, CMS launched its Acute Hospital Care At Home program, which provides eligible hospitals with regulatory flexibilities to treat eligible patients in their homes. This program is for beneficiaries who require acute inpatient admission to a hospital and require at least daily rounding by a physician and a medical team to monitor their care needs on an ongoing basis.

Specifically, CMS announced that it is accepting waiver requests to waive sections of the Hospital Conditions of Participation that require nursing services to be provided on the premises 24 hours a day, 7 days a week, and the immediate availability of a registered nurse for care of any patient. CMS stated that it believes treatment for more than 60 acute conditions, such as asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease, could be treated appropriately and safely in home settings with proper monitoring and treatment protocols.

Hospitals that participate will be required to have appropriate screening protocols in place to assess medical and non-medical factors, including working utilities, assessment of physical barriers, and screenings for domestic violence concerns. Medicare beneficiaries will be admitted only from emergency departments and inpatient hospital beds, and an in-person evaluation by a physician will be required prior to starting care at home. In addition, a registered nurse must evaluate each patient once daily, either in person or remotely, and there must be two in-person visits per day by either registered nurses or mobile integrated health paramedics, based on the patient’s nursing plan and hospital policies. Finally, CMS indicated that it is the patient’s choice whether to receive these services in the home or in the traditional hospital setting, and patients who do not wish to receive the services in home will not be required to.

CMS has launched an online portal to allow hospitals to begin the waiver request process. CMS stated in its press release that it would require hospitals to report quality and safety data to CMS at a frequency based on hospitals’ prior experience with the Hospital At Home model.

More information on the Acute Hospital Care At Home Program and the new online portal are available here. The agency also published a Frequently Asked Questions document, which is available here.

ASC Flexibility

As part of the Hospital Without Walls initiative, CMS previously announced regulatory flexibility that allowed ASCs the ability to be temporarily certified as hospitals and provide inpatient care for longer periods than normally allowed, with the appropriate staffing in place. As part of the expanded flexibilities, CMS clarified that participating ASCs need only provide 24-hour nursing services when there are one or more patients receiving care onsite.

The program change provides ASCs enrolled as hospitals the ability to flex up their staffing when needed and provide relief in communities experiencing hospital capacity constraints while not mandating that nurses be present when no patients are in the ASC. More information on the ASC flexibilities is available here, and a Frequently Asked Questions document is available here.

Medicare Telehealth

CMS has expanded the scope of Medicare telehealth to allow beneficiaries to receive telehealth services from any location, including their homes. CMS also added over 135 services, such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth.

For a copy of CMS’s press release regarding the initiatives above, please click here.

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King & Spalding

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