Home Health & Hospice Week

Make sure you understand the differences between the home health benefit and the hospital program.

Patients may feel thankful for Medicare’s pre-Thanks­giving announcement that it will broaden its Hospitals Without Walls program, making hospital services at home available to more beneficiaries.

“With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that [Centers for Medicare & Medicaid Services] regulations are not standing in the way of patient care for COVID-19 and beyond,” said CMS Administrator Seema Verma in a Nov. 25 release announcing the change.

Background: When COVID hit in March, “CMS announced the Hospitals Without Walls program, which provides broad regulatory flexibility that allowed hospitals to provide services in locations beyond their existing walls,” CMS notes in the release.

Now, “CMS is expanding on this effort by executing an innovative Acute Hospital Care At Home program, providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes,” the agency says. “CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.”

In addition to avoiding visitor restrictions, “patients and their families not diagnosed with COVID-19 may prefer to receive care in their homes if local hospitals are seeing a larger number of patients with COVID-19,” CMS says. “It is the patient’s choice,” the agency adds. “Patients who do not wish to receive [hospital services] in the home will not be required to.”

Difference: The Acute Hospital Care At Home program “clearly differentiates the delivery of acute hospital care at home from more traditional home health services,” CMS explains in the release. “While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis.”

Another difference: In a new Frequently Asked Ques-tion, a hospital asks CMS “does my organization have to report to OASIS to participate in the Acute Hospital Care at Home initiative?” according to the FAQ set. “No, this program is designed for patients who meet acute inpatient or overnight observation admission criteria for hospital-level care,” CMS responds. “The patient’s home is considered part of the hospital during the admission.”

“CMS has taken an extraordinary step … facilitating the rapid expansion of Hospitalization at Home, an innovative care model with proven results,” says physician Kenneth L. Davis, CEO of the Mount Sinai Health System in New York City, one of the six hospitals first granted the waiver. “This important and timely move will enable hospitals across the country to use effective tools to safely care for patients during this pandemic,” Davis says in a separate CMS release.

How it works: “The new program will require an in-person physician evaluation and screening protocols to assess medical and non-medical factors before care at home begins, with beneficiaries admitted only from emergency departments and inpatient hospital beds,” the American Hospital Association explains. “A registered nurse will evaluate each patient once daily in person or remotely, and either registered nurses or mobile integrated health paramedics will conduct two in-person visits daily based on the patient’s nursing plan and hospital policies,” says the trade group, which has been urging the feds to expand its Hospitals Without Walls program since the fall COVID surge began.

CMS is accepting waiver applications from hospitals to conduct such programs at https://qualitynet.cms.gov/acute-hospital-care-at-home. There is a streamlined application process for hospitals that have treated at least 25 patients in such programs already. CMS initially approved waivers for “six health systems with extensive experience providing acute hospital care at home,” the agency adds, with more expected soon.

There is no end date for the program in the CMS announcement. But the waiver application notes that “This waiver is only in effect for the duration of the COVID-19 Public Health Emergency.”