Nearing Regulatory Cliff, Hospital-at-Home Stakeholders Throw Support Behind Waiver Extension

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The U.S. Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver has, no doubt, ushered in a new era for hospital at home. But with calls to end the public health emergency (PHE), it is hanging in the balance.

Gone are the days when the hospital-at-home model was considered a niche care service. Since the launch of the waiver, there have been 92 health systems and 204 hospitals in 34 states approved for Acute Hospital Care at Home, according to CMS.

“There are a number of programs that have been launched, and the risk is that all of these waivers are tied to the public health emergency,” Dr. Stephen Parodi, associate executive director for The Permanente Medical Group, told Home Health Care News. “With COVID waning, … we expect that the public health emergency will likely expire sometime this year. There is a need, from a regulatory standpoint, to avoid these programs ending if the waiver goes away.”

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The waiver was meant to lift barriers that would impede care during the pandemic. Currently, the PHE will be active through April 16, but it will likely be extended at least once more.

In comes the “Hospital Inpatient Services Modernization Act.” The bill was introduced earlier this month and 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.).

If enacted into law, the legislation would extend the Acute Hospital Care at Home waiver by two years past the PHE.

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Additionally, the legislation would require CMS to form regulations around health and safety requirements for the program within a year of its enactment. Parodi believes that the development of these regulations is necessary for the program’s success

“Programs like ours have been already developing those measurements because we want to hold ourselves to the same standards that we do in traditional, brick-and-mortar hospitals,” he said. “We need to be able to understand which programs work best and what are the best practices. Ultimately, this needs to be based on person-centered care.”

Other hospital-at-home stakeholders have echoed those thoughts.

The introduction of the legislation is one of the first “big steps” in working on getting an extension of the Acute Hospital Care at Home waiver, Jeremiah McCoy, director of policy and government relations at Moving Health Home, told HHCN.

Although McCoy notes that the Acute Hospital Care at Home waiver has received less attention than some of the other PHE flexibilities, such as telehealth, he believes there is bipartisan support for the waiver across Capitol Hill.

Moving Health Home’s advocacy efforts

For its part, Moving Health Home has made educating capitol hill staffers a major part of its advocacy efforts.

“We’ve been putting health systems that are actually providing hospital-at-home services through the waiver in front of Hill staff to build that support,” McCoy said. “There’s a lot of education that needs to happen with Hill staff. We are working to make sure they know about the waiver, where the benefits are, the impacts on cost, quality, patient satisfaction and health equity.”

Increasing awareness will be the biggest challenge for the legislation, according to Moving Health Home.

“There are so many things to keep track of in relation to pandemic flexibilities,” Krista Drobac, founder of Moving Health Home, told HHCN. “The Senate Finance Committee held a hearing and highlighted this, but I don’t think it was enough to really raise its awareness among Hill staff.”

A number of health care groups came together and penned a letter urging Congress to pass the Hospital Inpatient Services Modernization Act, hoping to further highlight the urgency of the issue for lawmakers in Washington, D.C.

Along with Moving Health Home, the American Medical Association, the American Academy of Home Care Medicine, Atrium Health, Kaiser Permanente, Mayo Clinic and others signed the letter.

“There’s a lot of interest and support for the waiver, we just need to continue to build on that and make sure that the Hill is hearing what everyone’s saying, not only for what the opportunity has been during the pandemic, but what this means for a future iteration of the acute care home model in Medicare,” McCoy said.

Overall, the recently introduced legislation has received widespread support from the health care sector at large. But some legal experts have suggested that it may not be enough.

“There may be additional state law barriers that influence whether hospitals can utilize the Acute Hospital Care at Home programs after the [public health emergency] ends since states often have regulations similar to CMS’ conditions of participation that may similarly need to be waived to not conflict with state hospital licensure laws,” Foley & Lardner attorneys wrote in a recent article.

Another area of concern is that the bill only extends the availability of inpatient hospital services.

“[This] is important because – even with the recently enacted Consolidated Appropriations Act of 2022, which would extend the availability to provide and bill Medicare for telehealth services for patients in the home for 151 days post [public health emergency] – there could be barriers for patients continuing to receive care in the home once they no longer justify inpatient admission,” the attorneys wrote.

Lastly, they point to critics’ stance that a two-year waiver is not long enough to understand or see the effectiveness of the program. Some have suggested that a five or seven-year waiver would be more appropriate.

Ultimately, McCoy believes there’s a case for going after just a two-year extension of the waiver.

“Our perspective has always been that we like to see a two-year extension because this is just a waiver,” he said. “We don’t think that we should build permanent policies based on waivers. We really need to think about what the next iteration should look like. The payment structure is at parity with how hospitals are paid today. They made no modifications to reflect the home setting. Obviously, that needs to be considered in a more permanent model.”

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