Advocacy Tools

The ACH Coalition brings together stakeholders to create a pathway to coverage for advanced care at home services. As we build momentum to extend the Acute Hospital Care at Home waiver past 2024, the Frequently Asked Questions resource serves to define hospital at home, differentiate it from home health, describe the process of establishing hospital at home programs within hospitals and health systems, and explain why a five-year waiver extension is needed.

The ACH Coalition supports the extension of the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCAH) waiver through 2029, which would express an ongoing federal commitment to increasing access to care in the home. According to CMS, 378 hospitals across 140 systems in 39 states are currently approved for the AHCAH waiver program.

This tool visualizes the increasing participation in the waiver and scaling of hospital at home programs across the nation. Tracking individual hospitals and the participating systems and states, the handout reflects the latest facilities/systems approved by CMS as of Nov. 27.

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.

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.