The Bipartisan Policy Center released a report on Wednesday that recommends that Congress reauthorize the pandemic-era Acute Hospital Care at Home waiver for five years so more hospitals and patients can benefit.
The Centers for Medicare and Medicaid Services’ (CMS) “hospital at home” waiver has allowed hospitals to provide acute, in-patient level care to qualifying patients in their homes. The waiver was offered during the COVID-19 pandemic when hospitals were overwhelmed with COVID patients and HHS sought to decompress hospital capacity. The hospital-at-home waiver will expire in December without Congressional action.
According to the BPC report, 331 hospitals in 37 states have been granted a hospital-at-home waiver by CMS since 2020. But BPC notes that many of the authorized hospitals do not have programs up and running due to financial and operational burdens. In 2022, of 284 authorized hospitals only 37% were treating patients.
BPC wants the acute hospital care at home model to continue for at least another five years and recommends that CMS collects quantitative and qualitative data to inform Congress if the program should be permanent, modified or reauthorized in 2028.
A five-year extension would allow hospitals to invest in their programs and could prompt state Medicaid programs to cover the care model. Only eight states pay for the program, so most Medicaid beneficiaries cannot participate.
It also wants to increase hospital uptake of the program. While hundreds of hospitals have joined into the program, they only make up 5% of all hospitals and 15% of academic medical centers.
BPC is focused on actions to diversify the patients who are selected for hospital-at-home programs, including people with disabilities, people with low incomes and people who live in rural areas.
It also says that CMS should give hospitals more guidance on minimum standards for hospital-at-home programs. BPC recommends CMS create quality standards for hospital-at-home programs and notes that it could take years to get to this point.
BPC’s lobbying arm, BPC Action, will push for the recommendations to be included in legislation that reauthorizes pandemic-era waivers, like telehealth visits for Medicare beneficiaries. Two House committees have marked up legislation that would extend the AHCAH for five years, through 2028.
Krista Drobac, CEO of Moving Health Home, a trade organization pushing for the expansion of home-based care, said she’s happy to see the increased attention on the hospital-at-home waiver. Drobac is also pushing for a five-year extension of hospital at home.
However, Drobac believes a straight five-year extension of the program is most likely to pass through Congress, minus BPC’s bells and whistles.
The Bipartisan Policy Center also sent recommendations to Congress in July on a plan to extend Medicare telehealth waivers, which will expire in December along with hospital at home.
While BPC notes that a two-year extension of Medicare telehealth flexibilities is likely, it tells Congress there is enough evidence to make key flexibilities permanent. BPC recommends Congress permanently remove originating and geographic site restrictions for telehealth, allow federally qualified health centers to permanently act as distant sites for telehealth visits, allow all Medicare providers to bill for telehealth and remove the in-person visit requirement for telemental health care.
Assuming a two-year extension occurs, BPC urges Congress to direct CMS to study and propose a long-term telehealth reimbursement strategy for facility settings, non-facility settings and safety net providers by June 2026.
"Notably, several large private payers—which have traditionally followed Medicare’s lead on coverage and reimbursement policies—have reverted to paying less for virtual care in recent years," BPC wrote.
BPC floats reimbursement changes for telehealth included paying a percentage of the in-person rate, which could allow CMS to easily adjust telehealth payment going forward. BPC also says CMS could consider a payment bundle or partial capitation for brief virtual visits, the report says.
BPC also addresses quality of care concerns and proposes that virtual-only providers, including national telehealth companies, bill Medicare visits using a modifier that would identify them as a virtual-only provider. BPC says the modifier will maintain program integrity and root out bad actors.
It also recommends other controls for quality and program integrity like appropriate funding for HHS' Office of the Inspector General. Congress should also require an in-person visit before telehealth providers can order high-cost lab tests and durable medical equipment, the report says.