Lawmakers Rubio, Carper Introduce Bill To Expand Hospital-At-Home Care In US

Two senators introduced a bill Thursday that would create a pilot program aimed at expanding the scope of hospital-at-home care in the U.S.

Dubbed the At Home Observation and Medical Evaluation (HOME) Services Act, the bill was introduced specifically by Sens. Marco Rubio (R-Fla.) and Tom Carper (D-Del.). Sen. Marsha Blackburn (R-Tenn.) was an original cosponsor of the legislation.

The bill would build off of the Acute Hospital Care at Home (AHCAH) program, which was created by the Centers for Medicare & Medicaid Services (CMS) through a waiver during the height of the COVID-19 pandemic.


As of Feb. 2, 312 hospitals across 131 health systems have been approved to participate. The program was extended past its original expiration date, and the flexibilities associated with it will last through 2024.

While the AHCAH program covers only acute patients, the HOME Services Act would include “observation status patients.” Broadly, an observation status patient is generally someone waiting to hear from a health system on whether they will be admitted to the hospital or discharged.

“Addressing our health care challenges requires innovative solutions,” Sen. Rubio said in a statement. “The HOME Services Act builds on the success of the hospital-at-home program to lower costs and burdens and improve patient outcomes and satisfaction.”


Even outside of the AHCAH program, the hospital-at-home model has grown significantly in prominence over the last few years. Health systems have created their own programs outside of the AHCAH, and select payers have begun supporting the model as well.

The AHCAH program itself has delivered very promising results.

Of the 11,159 patients who received care from November 2021 to March 2023, only 7.2% of patients that were being treated in the home were transferred to the hospital, according to a recent study published by JAMA.

In the past, health system leaders have had gripes with the narrow limits of the AHCAH program, however. The HOME Services Act, if passed, would be significant in expanding those limits, as it would allow health systems to place patients in at-home programs prior to reaching a higher level of acuity.

“The pandemic taught us that meeting patients where they’re at is possible and often preferred,” Sen. Carper said in a statement. “That’s why I worked to increase and expand access to hospital-level care from the comfort of home. These services have seen tremendous success for people across the country, including in Delaware, and the At HOME Services Act would build on these programs to continue reducing costs and improving patient outcomes.”

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