CMS Hospital Flexibilities During the Pandemic

Background Excerpt

In response to the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) issued several flexibilities via its waiver and regulatory authorities aimed at helping hospitals maximize their capacity to treat patients. In March 2020, CMS launched the Hospitals without Walls Initiative, a broad range of waivers and flexibilities to allow hospitals to treat patients in alternate care settings outside the hospital – such as ambulatory surgery centers, inpatient rehabilitation hospitals, and hotels – while still receiving hospital reimbursement rates for services. For example, a healthcare system could use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients. The Initiative aimed to enable hospitals to transition patients to other care settings as appropriate in order to have space for the influx of COVID-19 patients.

Hospital Inpatient Services Modernization Act Tools for Advocacy


CMS implemented the AHCAH waiver program to allow Medicare beneficiaries the option to receive acute-level health care services in their home environment during the COVID-19 Public Health Emergency (PHE). The waiver program has allowed hospitals and health systems across the country to meet increased capacity demands during the pandemic, while providing safe, high-quality care in patients’ homes where they can be supported by their friends and family. Hospitals and health systems across 34 states are currently participating in this waiver program. The waiver program has demonstrated positive outcomes, experiences, and potential cost savings, and it has reinforced the need for broader adoption of advanced care at home.

However, the federal regulatory flexibilities that enable this model are tied to the PHE, which expires every 90 days and is limited in its duration. Patients and their health care providers need greater stability and certainty to continue investing in the model as long-term option to safely and comfortable receive acute-level services in the home.

On March 10, 2022, to provide this stability and sustain the existing momentum and investment in the AHCAH waiver program, the Senate and the House have introduced Hospital Inpatient Services Modernization Act, bipartisan legislation, S. 3792 and H.R. 7053, that would extend Centers for Medicare & Medicaid Services (CMS) waiver flexibilities currently tied to the Public Health Emergency (PHE) determination. These flexibilities bring hospital-level care directly to patients in their homes, helping to reduce costs and enhance patient experiences. The legislation, introduced by Senators Tom Carper (D-DE) and Tim Scott (R-SC) in the Senate alongside Congressmen Earl Blumenauer (D-OR) and Brad Wenstrup, (R-OH) in the House of Representatives, would extend the current acute hospital care at home waiver flexibilities for two years from the end of the COVID-19 Public Health Emergency (PHE).

Over 110 organizations signed a letter submitted to House Speaker Pelosi, Leader McCarthy, Leader Schumer, and Leader McConnell in support of the passage of these bills.

Data Visualization Slides (click to enlarge)

Individual Letters of Support

March 21, 2022 | View Support Letter