PRIA, Government Policy, Made Personal

Summary

The Secretary of Health and Human Services must let hospitals keep using the special waivers and flexibilities from the Acute Hospital Care at Home program for inpatient admissions that happen from the day after the emergency period in section 1320b–5(g)(1)(B) ends through September 30, 2030. A hospital can get these waivers if it asks for them and meets certain rules. The waivers include things like not having to provide 24-hour on‑site nursing or some Life Safety Code rules, letting inpatient care be given outside the hospital, allowing the patient’s home to be an approved telehealth site, and other waivers that were in place on December 29, 2022. To qualify, a hospital must set and use clear criteria to make sure patients really need inpatient care and have a doctor note that in the medical record; give the same standard of care at home as in the hospital; only enroll inpatients or emergency patients who meet the inpatient criteria; follow patient safety rules the Secretary requires (except for rules that are waived); and give data to the Secretary for monitoring and study. The Secretary can remove a hospital from the program if it stops meeting these requirements. The Secretary must do two studies and publish reports. By September 30, 2024, there must be a study posted on the CMS website that looks at the hospitals’ criteria and compares care quality, diagnoses, costs, services used, and basic socioeconomic data for patients. By September 30, 2029, a more detailed study must compare care quality, readmissions, deaths, length of stay, infections, transfers, costs, staffing, service intensity, caregiver involvement, and socioeconomic factors between home‑care patients and similar inpatients; that report must be sent to the House Ways and Means Committee and the Senate Finance Committee and posted on the CMS website. Congress provided $5,000,000 for fiscal year 2023 and $2,500,000 for fiscal year 2026 to help carry out these requirements. The Secretary may run the program by official instructions and should make the collected information available on Medicare.gov when possible.

Title 42, §1395cc–7

The Public Health and Welfare, Source: USLM XML via OLRC

(a)(1)With respect to inpatient hospital admissions occurring during the period beginning on the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title and ending on September 30, 2030, the Secretary of Health and Human Services shall grant waivers and flexibilities (as described in paragraph (2)) to an individual hospital that submits a request for such waivers and flexibilities and meets specified criteria (as described in paragraph (3)) in order to participate in the Acute Hospital Care at Home initiative of the Secretary.

(2)For the purposes of paragraph (1), the waivers and flexibilities described in this paragraph are the following waivers and flexibilities that were made available to individual hospitals under the Acute Hospital Care at Home initiative of the Secretary during the emergency period described in section 1320b–5(g)(1)(B) of this title:

(A)Subject to paragraph (3)(D), waiver of the requirements to provide 24-hour nursing services on premises and for the immediate availability of a registered nurse under section 482.23(b) of title 42, Code of Federal Regulations (or any successor regulation), and the waivers of the physical environment and Life Safety Code requirements under section 482.41 of title 42, Code of Federal Regulations (or any successor regulation).

(B)Flexibility to allow a hospital to furnish inpatient services, including routine services, outside the hospital under arrangements, as described in Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID–19 (87 Fed. Reg. 71748 et seq.).

(C)Waiver of the telehealth requirements under clause (i) 11 So in original. Probably should be “clause (iii)”. See References in Text note below. of section 1395m(m)(4)(C) of this title, as amended by section 4113(a) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022, such that the originating sites described in clause (ii) of such section shall include the home or temporary residence of the individual.

(D)Other waivers and flexibilities that, as of December 29, 2022, were in place for such initiative during such emergency period.

(3)For purposes of paragraph (1), the specified criteria for granting such waivers and flexibilities to individual hospitals are:

(A)The hospital shall indicate to the Secretary the criteria it would use to ensure that hospital services be furnished only to an individual who requires an inpatient level of care, and shall require that a physician document in the medical record of each such individual that the individual meets such criteria.

(B)The hospital and any other entities providing services under arrangements with the hospital shall ensure that the standard of care to treat an individual at home is the same as the standard of care to treat such individual as an inpatient of the hospital.

(C)The hospital shall ensure that an individual is only eligible for services under paragraph (1) if the individual is a hospital inpatient or is a patient of the hospital’s emergency department for whom the hospital determines that an inpatient level of care is required (as described in subparagraph (A)).

(D)The hospital shall meet all patient safety standards determined appropriate by the Secretary, in addition to those that otherwise apply to the hospital, except those for which the waivers and flexibilities under this subsection apply.

(E)The hospital shall provide to the Secretary, at a time, form and manner determined by the Secretary, any data and information the Secretary determines necessary to do the following:

(i)Monitor the quality of care furnished, and to the extent practicable, ensure the safety of individuals and analyze costs of such care.

(ii)Undertake the studies described in subsections (b) and (c).

(F)The hospital meets such other requirements and conditions as the Secretary determines appropriate.

(4)The Secretary may terminate a hospital from participation in such initiative (and the waivers and flexibilities applicable to such hospital) if the Secretary determines that the hospital no longer meets the criteria described in paragraph (3).

(b)(1)The Secretary shall conduct a study to—

(A)analyze, to the extent practicable, the criteria established by hospitals under the Acute Hospital Care at Home initiative of the Secretary to determine which individuals may be furnished services under such initiative; and

(B)analyze and compare, to the extent practicable—

(i)quality of care furnished to individuals with similar conditions and characteristics in the inpatient setting and through the Acute Hospital Care at Home initiative, including health outcomes, hospital readmission rates, hospital mortality rates, length of stay, infection rates, and patient experience of care;

(ii)clinical conditions treated and diagnosis-related groups of discharges from the inpatient setting and under the Acute Hospital Care at Home initiative;

(iii)costs incurred by furnishing care in the inpatient setting and through the Acute Hospital Care at Home initiative;

(iv)the quantity, mix and intensity of such services (such as in-person visits and virtual contacts with patients) furnished in the Acute Hospital Care at Home initiative and furnished in the inpatient setting; and

(v)socioeconomic information on beneficiaries treated under the initiative, including racial and ethnic data, income, and whether such beneficiaries are dually eligible for benefits under this subchapter and subchapter XIX.

(2)Not later than September 30, 2024, the Secretary of Health and Human Services shall post on a website of the Centers for Medicare & Medicaid Services a report on the study conducted under paragraph (1).

(3)In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2023, out of any amounts in the Treasury not otherwise appropriated, $5,000,000, to remain available until expended, for purposes of carrying out this section.

(c)(1)Not later than September 30, 2029, the Secretary shall conduct a study to—

(A)analyze, to the extent practicable, the criteria established by hospitals under the Acute Hospital Care at Home initiative to determine which individuals may be furnished services under such initiative; and

(B)analyze and compare (both within and between hospitals participating in the initiative, and relative to comparable hospitals that do not participate in the initiative, for relevant parameters such as diagnosis-related groups)—

(i)quality of care furnished to individuals with similar conditions and characteristics in the inpatient setting and through the Acute Hospital Care at Home initiative, including health outcomes, hospital readmission rates (including readmissions both within and beyond 30 days post-discharge), hospital mortality rates, length of stay, infection rates, composition of care team (including the types of labor used, such as contracted labor), the ratio of nursing staff, transfers from the hospital to the home, transfers from the home to the hospital (including the timing, frequency, and causes of such transfers), transfers and discharges to post-acute care settings (including the timing, frequency, and causes of such transfers and discharges), and patient and caregiver experience of care;

(ii)clinical conditions treated and diagnosis-related groups of discharges from inpatient settings relative to discharges from the Acute Hospital Care at Home initiative;

(iii)costs incurred by the hospital for furnishing care in inpatient settings relative to costs incurred by the hospital for furnishing care through the Acute Hospital Care at Home initiative, including costs relating to staffing, equipment, food, prescriptions, and other services, as determined by the Secretary;

(iv)the quantity, mix, and intensity of services (such as in-person visits and virtual contacts with patients and the intensity of such services) furnished in inpatient settings relative to the Acute Hospital Care at Home initiative, and, to the extent practicable, the nature and extent of family or caregiver involvement;

(v)socioeconomic information on individuals treated in comparable inpatient settings relative to the initiative, including racial and ethnic data, income, housing, geographic proximity to the brick-and-mortar facility and whether such individuals are dually eligible for benefits under this subchapter and subchapter XIX; and

(vi)the quality of care, outcomes, costs, quantity and intensity of services, and other relevant metrics between individuals who entered into the Acute Hospital Care at Home initiative directly from an emergency department compared with individuals who entered into the Acute Hospital Care at Home initiative directly from an existing inpatient stay in a hospital.

(2)In conducting the study under paragraph (1), the Secretary shall, to the extent practicable, analyze and compare individuals who participate and do not participate in the initiative controlling for selection bias or other factors that may impact the reliability of data.

(3)Not later than September 30, 2029, the Secretary of Health and Human Services shall—

(A)submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the study conducted under paragraph (1); and

(B)make such report publicly available on a website of the Centers for Medicare & Medicaid Services.

(4)In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $2,500,000, to remain available until expended, for purposes of carrying out this section.

(d)Notwithstanding any other provision of law, the Secretary may implement this section by program instruction or otherwise.

(e)The Secretary shall, as feasible, make the information collected under subsections (a)(3)(E), (b)(1), and (c)(1) available on the Medicare.gov internet website (or a successor website).

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 4113(a) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022, referred to in subsec. (a)(2)(C), is section 4113(a) of div. FF of Pub. L. 117–328, which amended subsec. (m)(2)(B)(iii), (4)(C)(iii) of section 1395m of this title.

Amendments

2026—Subsec. (a)(1). Pub. L. 119–75, § 6210(a), substituted “

September 30, 2030” for “

January 30, 2026”. Subsec. (a)(3)(E). Pub. L. 119–75, § 6210(b)(1)(B), added concluding provisions. Subsec. (a)(3)(E)(ii). Pub. L. 119–75, § 6210(b)(1)(A), substituted “the studies described in subsections (b) and (c)” for “the study described in subsection (b)”. Subsec. (b). Pub. L. 119–75, § 6210(b)(2)(A), substituted “Initial Study” for “Study” in heading. Subsec. (b)(3). Pub. L. 119–75, § 6210(b)(2)(B), substituted “section” for “subsection”. Subsecs. (c), (d). Pub. L. 119–75, § 6210(b)(3), (4), added subsec. (c) and redesignated former subsec. (c) as (d). Former subsec. (d) redesignated (e). Subsec. (e). Pub. L. 119–75, § 6210(b)(3), (5), redesignated subsec. (d) as (e) and substituted “, (b)(1), and (c)(1)” for “and (b)(1)”. 2025—Subsec. (a)(1). Pub. L. 119–37 substituted “

January 30, 2026” for “

September 30, 2025”. Pub. L. 119–4 substituted “

September 30, 2025” for “

March 31, 2025”. 2024—Subsec. (a)(1). Pub. L. 118–158 substituted “

March 31, 2025” for “December, 31, 2024”.

§1395cc–7 Extension of Acute Hospital Care at Home Initiative