Providers are once again watching a looming deadline at the end of the month when waivers that allow hospitals to deliver acute care in patients’ homes could lapse, creating administrative complexity and uncertainty for providers, experts say.
The program is set to expire in just a few weeks absent congressional action. If it does, hospitals may have to physically relocate patients back to facilities, a costly process that experts say could harm both patients and providers.
The Acute Hospital Care at Home Program was created by the CMS at the height of the COVID-19 pandemic in 2020 in a bid to help hospitals manage an influx of patients and ease capacity challenges.
The program allows approved hospitals to provide acute care in patients’ homes and clears a regulatory pathway to reimburse hospitals for those services. Today, nearly 380 facilities participate in the initiative across 37 states, according to the CMS.
But the program is temporary and subject to reauthorization by Congress. Like flexibilities that expanded telehealth coverage in Medicare, the initiative has been preserved for short periods over the past year — and the program lapsed entirely for weeks during the historically long government shutdown last fall.
Lawmakers’ spending plan that ended the shutdown only extended the hospital at home program through Jan. 30. If that deadline passes without congressional action, hospitals will again have to move patients to facilities from their homes, a significant undertaking for providers and a potential safety risk for patients, experts say.
“It takes enormous resources and coordination for health systems to be able to ensure that patient care is not sacrificed,” said Jeff Wurzburg, partner at law firm Norton Rose Fulbright.
Resource strain, regulatory risk when waivers expire
The possible expiration creates a host of challenges for health systems managing hospital at home programs only months after facilities managed a weekslong lapse during the government shutdown, experts say.
During the government shutdown last fall, when waivers expired, hospitals were forced to “discharge” patients from their homes back to inpatient facilities, according to Cal Stein, partner at law firm Troutman Pepper Locke. Some health systems paused or pared back their programs, contributing to capacity strain at some facilites, according to reporting by Politico.
Around 90% of hospital at home programs said they were impacted by the shutdown, with providers reporting a significant decline in daily admissions, according to a survey conducted by the Hospital at Home Users Group.
Experts say hospitals could face similar challenges if Congress doesn’t extend the waiver past Jan. 30.
For example, hospitals have to ensure they have enough beds available at brick-and-mortar facilities for incoming patients, as well as the staff available to care for them, Stein said.
Medical complications can also arise when patients are transferred between facilities. That could create legal risk for hospitals that might face allegations that transfers weren’t handled correctly, or there weren’t enough staff at inpatient facilities to handle the influx of patients, Stein added.
Patients might struggle to access care too, particularly if they don’t live nearby an inpatient facility where they could be easily moved, he said. Some might also not want to transfer to a hospital and instead stay in their homes.
“They could stay, but the reimbursement from Medicare wouldn’t be there,” Stein said. “So the facilities and the patients are really put in between a rock and a hard place by the expiration of that program.”
Hope for a long-term solution
Providers want Congress to avoid more temporary extensions of the hospital at home program and instead focus on a longer-term fix, experts say.
One possible solution could come from a bill that passed in the House in early December that would preserve the waivers for five years, through Sept. 30, 2030. That move shows the program is popular with lawmakers, but it’s unclear if Congress will pass the bill, Wurzburg said.
“It is emblematic of the support that the program has in Congress,” he said. “But in the meantime, there can be real harm financially for hospitals and providers, and in terms of care and convenience for patients and beneficiaries.”
A five-year extension could push more facilities to move forward with hospital at home programs, said Tom Kiesau, managing partner and chief AI and digital officer at consultancy Chartis.
Hospital at home programs can help limit expensive inpatient stays and improve hospital capacity — a key concern as the population ages and needs more care, he added.
A study published by the CMS in 2024 found hospital at home beneficiaries had slightly shorter lengths of stay compared with inpatients, and lower Medicare spending 30 days after discharge — although researchers warned differences in clinical complexity make it difficult to conclude if hospital at home lowers Medicare spending overall. Patients, caregivers and providers reported positive experiences with the initiative, according to the research.
But building out the infrastructure to support them takes resources, and providers might be less likely to embark on hospital at home initiatives without more certainty on the program, Kiesau added.
“I think you’re going to see health systems just continue to say that signals a level of uncertainty that just makes it less of a priority,” he said.
