On Nov. 25, 2020, the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) announced that it is accepting applications to waive certain CMS Hospital Conditions of Participation to allow hospital in-home care during the COVID-19 pandemic. This new Acute Hospital Care at Home program builds upon CMS' expansion of telehealth coverage early in the pandemic to allow Medicare beneficiaries to receive telehealth services from more locations, including their homes. Some hospitals have already been providing this service to private insurance patients.
Current federal Medicare participation rules require nursing services to be provided on hospital premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient pursuant to 42 C.F.R. § 482.23(b) and (b)(1). CMS is accepting waiver requests to waive these requirements. Hospitals must meet certain standards to participate, including:
- In-person physician evaluation prior to start of care at home.
- Twice-daily visits by medical workers—one of the two daily visits must be by a registered nurse.
- Provide equipment such as blood pressure and oxygen-level monitors.
- Connect patients via an iPad or other device to a command center should the patient need assistance.
CMS announced Medicare will pay hospitals the same rate as for in-hospital care. The program differentiates the delivery of acute hospital care at home from more traditional home health services. While home health care provides 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.
Waiver requests will be divided into two categories based on a hospital's prior experience. Hospitals must submit the waiver request for individual CMS Certification Numbers, not entire systems. For those hospitals which have provided at home acute hospital services to at least 25 patients previously, an expedited process will be conducted and include hospital attestation to specific existing beneficiary protections and reporting requirements. These hospitals will be required to submit monitoring data to CMS on monthly basis.
For those hospitals which have treated fewer than 25 patients or have never provided at home acute hospital services, a more detailed waiver request will be required which emphasizes internal processes that prove capability of treating acute hospital care at home patients with the same level of care as traditional inpatients. This group will consist of some hospitals which are part of a larger, experienced health system, as well as hospitals without any prior experience that are not part of a health system with experience. These hospitals will be required to submit monitoring data to CMS on a weekly basis.
CMS issued FAQs on the new program, available here.
As health care providers continue to care for patients in all health care specialties, your Taft attorneys are available to answer questions that may arise, including with respect to launching and treating via telehealth and obtaining reimbursement for those services.
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