The Centers for Medicare & Medicaid Services (CMS) announced on Nov. 25 that it was expanding its Hospitals Without Walls program to allow hospitals to treat certain patients in their homes rather than admitting them into an acute inpatient setting.
Under the Acute Hospital Care at Home waiver, hospitals would be allowed to provide care in a patient’s home and receive Medicare payment under the Inpatient Protective Payment System. The program waives §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, seven days a week and the immediate availability of a registered nurse for care of any patient. It is not a blanket waiver; instead, hospitals would be required to apply for a waiver. The program is expected to last the duration of the public health emergency.
As part of the waiver requirements, patients must be under continuous remote monitoring by a hospital team member and be visited by a nurse or Mobile Integrated Health paramedic at least two times a day to collect vital signs and assess the patient. Physicians and nonphysician practitioners are required to evaluate the patient at least once a day, but these evaluations can be conducted remotely after the initial evaluation. In the event of an emergency, hospitals would be required to respond immediately upon demand through a remote audio connection. Hospitals can also activate 911 or emergency paramedics that are required to reach the patient within 30 minutes.
As a condition of the hospital at home waiver, hospitals must attest that they can provide or contract for services to be provided in the home that are routinely available in the hospital such as pharmacy; infusion; respiratory care including oxygen; durable medical equipment; and physical, occupational, and speech therapy.
FAQs about the waiver can be accessed here.