Bill Aiming to Significantly Extend the Acute Hospital Care at Home Waiver Introduced

A bill that would extend the Acute Hospital Care at Home waiver has finally been introduced.

Dubbed the “Hospital Inpatient Services Modernization Act,” the bill is sponsored by Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.), as well as Reps. Brad Wenstrup (R-Ohio) and Earl Blumenauer (D-Ore.).

The bill would extend the waivers that have made hospital-level care at home viable during the pandemic by two years, “beyond the duration of the COVID-19 public health emergency (PHE).” The PHE is still active through April 16.


“Acute hospital care at home waiver programs are providing high quality care to Medicare patients in their homes,” a group of providers wrote to lawmakers in a letter supporting the bill. “Studies of hospital-at-home programs regularly show significant reductions in 30-day readmissions, post-discharge emergency department visits and skilled nursing facility utilization.”

The legislation would also require the Centers for Medicare & Medicaid Services (CMS) to establish regulations regarding health and safety requirements for the program within a year of the bill’s enactment.

Teased for some time by home-based care insiders, the bill – though just introduced – offers hope that providers will not have built up capabilities that are all for naught. As of March 4, 92 health systems and 203 hospitals in 34 states had been approved to participate in the Acute Hospital Care at Home program.


“The benefits of advanced care at home will serve patients well beyond the pandemic,” Stephen Parodi, the executive vice president of The Permanente Federation at Kaiser Permanente, said in a statement. “By extending these flexibilities, Congress will create a predictable pathway for medical professionals to fully realize advances in the care delivery system that enable patients to be treated with safe, equitable and person-centered care in the comfort of their own homes.”

According to a press release issued by the Advanced Care at Home Coalition – a group of providers focused on delivering higher-acuity care in the home – Kaiser has delivered hospital-level care at home to more than 1,100 patients since the waiver program began.

It isn’t not alone either. While the initial entrants into the program got a head start, Parodi previously told Home Health Care News that many health systems had reached that 1,000-patient threshold.

“Over the course of the last year and a half, multiple systems have gotten 1,000 or more patients enrolled in these programs,” Parodi said in October. “We know that the waivers are tied to the PHE, whether it gets extended or not. But once that PHE expires, many of these programs are going to be facing a regulatory cliff.”

The Mayo Clinic is one of those, having treated more than 1,700 patients through the waiver since its onset.

“Our Mayo Clinic Advanced Care at Home patients tell us how much it means for them to recover at home,” Michael Maniaci, the physician leader for Mayo Clinic’s program, said in a statement. “We are grateful to Sens. Carper and Scott as well as Reps. Wenstrup and Blumenauer for their leadership on this critical issue. The Hospital Inpatient Services Act will allow patients to have the continued option to receive acute-level services in their home instead of a hospital.”

In addition to the hundreds of hospitals and health systems, adjacent contributors such as home health and home care agencies have also benefited from the waiver.

Agencies have partnered with health systems to help facilitate their programs, offering up their traditional “eyes and ears in the home” as well as expertise based on longtime experience in the setting.

A recent survey conducted by HHCN and Homecare Homebase found that hospital-at-home models were the No. 1 care model that home-based care providers were trying to get more involved with in 2022.

The future of hospital at home

Hospital at home was going to continue gaining steam – to an extent – with or without an extension of the waiver.

The success of hospital-at-home enablers proves that. For instance, Amedisys Inc. (Nasdaq: AMED) acquired Contessa Health, while Kaiser and the Mayo Clinic invested millions into Medically Home.

“The investment that they made into Medically Home sent an incredibly loud signal in the U.S. to other health systems, to CMS and to payers that they really believe in this model of decentralizing care,” Medically Home CEO Rami Karjian recently told HHCN.

The extension of the waiver is imperative to the success of hundreds of programs across the country. But given the resources and investment poured into the model over the last two years, it’s likely that some health systems were going to try to find a way to make hospital-level care in the home work either way.

In fact, some argued that the CMS waiver is currently set up in a way that delays hospital-at-home patient identification. 

“The waiver program – while well intended – is tough,” Christi McCarren, MultiCare’s senior vice president of retail health and community-based care, said in September at the FUTURE conference. “Our advanced care program, [for instance], identifies those patients in the community, whereas theCMS waiver program identifies them in the hospital.”

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