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CMS announces new flexibilities for care outside of a hospital setting amid COVID-19 surge

Medicare beneficiaries can receive telehealth services from any location, including their homes. 

Susan Morse, Managing Editor

CMS is allowing acute care for some health systems in the home. (Photo by Hugh Hastings/Getty Images)CMS is allowing acute care for some health systems in the home. (Photo by Hugh Hastings/Getty Images)

The Centers for Medicare and Medicaid Services has approved waivers for six health systems to provide acute care at home.

The hospitals include Brigham and Women's Hospital in Massachusetts; Huntsman Cancer Institute in Utah; Massachusetts General Hospital in Massachusetts; Mount Sinai Health System in New York City; Presbyterian Healthcare Services of New Mexico; and UnityPoint Health of Iowa. 

These hospitals already have experience providing acute hospital care at home, CMS said. The Acute Hospital Care at Home program was developed to support models of at-home hospital care that have seen success and have been reported in academic journals, including a major study funded by a Healthcare Innovation Award from the Center for Medicare and Medicaid Innovation, or CMMI, CMS's innovation center.

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The program 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.

CMS is in discussion with other health care systems and expects new applications to be submitted. CMS has launched an online portal for the waiver request process.

CMS anticipates patients may value the ability to spend time with family and caregivers at home without the visitation restrictions that exist in traditional hospital settings due to the public health emergency. Additionally, 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. 

It is the patient's choice to receive these services in the home or the traditional hospital setting and patients who do not wish to receive them in the home will not be required to.

Beneficiaries will only be admitted from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required prior to starting care at home. 

A registered nurse will evaluate each patient once daily either in person or remotely, and two in-person visits will occur daily by either registered nurses or mobile integrated health paramedics, based on the patient's nursing plan and hospital policies.

WHY THIS MATTERS
 
The acute care option and other flexibilities announced by CMS today have the aim of keeping patients out of the hospital as providers are seeing an increase in the number of patients with COVID-19.

The at-home acute care option will increase the capacity of a healthcare system dealing with a pandemic surge and help to keep patients safe, CMS said. 

The flexibilities for care outside a traditional hospital setting build on CMS's previous actions to expand the availability of telehealth across the nation.

AMBULATORY SURGICAL CENTER FLEXIBILITY

CMS has updated staffing flexibility designed to allow ambulatory surgical centers to provide greater inpatient care when needed. 

Ambulatory Surgical Centers are normally subject to a requirement that patients only remain in their care for less than 24 hours or require admission to a regular hospital.
 
CMS previously announced regulatory flexibility under Hospitals Without Walls to allow ASCs – facilities that normally provide same-day surgical care – to be temporarily certified as hospitals and provide inpatient care for longer periods than normally allowed, with the appropriate staffing in place. 
 
Today, CMS announced that participating ASCs need only provide 24-hour nursing services when there is actually one or more patients receiving care onsite. The program change provides ASCs enrolled as hospitals the ability to flex up their staffing when needed and provide an important relief valve in communities experiencing hospital capacity constraints, while not mandating nurses be present when no patients are in the ASC, CMS said. 

The flexibility is available to any of the 5,732 ASCs throughout the country and will be immediately effective for the 85 ASCs currently participating in the Hospital Without Walls initiative. 

TELEHEALTH

CMS has expanded the scope of Medicare telehealth to allow Medicare beneficiaries to receive telehealth services from any location, including their homes. 

CMS also added over 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services that will be reimbursed when delivered by telehealth. 

THE LARGER TREND

The Acute Hospital Care At Home program announced today is an expansion of the Hospitals Without Walls program CMS announced in March 2020.

The development of this program was informed by consultation with both academic and private sector industry leaders to ensure appropriate safeguards are in place to protect patients. 

CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.
 
Participating hospitals will be required to have appropriate screening protocols before care at home begins to assess both medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic violence concerns. 

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.
 
CMS will also closely monitor the program to safeguard beneficiaries by requiring hospitals to report quality and safety data to CMS on a frequency that is based on their prior experience with the Hospital At Home model.
 
ON THE RECORD

"We're at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need," said CMS Administrator Seema Verma. "With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com