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CMS expands hospitals’ flexibility for ‘at-home’ acute care

CMS on Wednesday said hospitals won’t have to provide around-the-clock access to nursing services for patients who receive acute care services at home.

In an update to its “Hospitals Without Walls” program that launched in March, CMS added new regulatory flexibilities that would allow hospitals to expand acute care services outside of their facilities.

Hospitals can apply for a waiver that would allow then to transfer Medicare and Medicaid beneficiaries who are in the emergency department or admitted as inpatients to their homes for continued care with daily monitoring, evaluations and in-person visits from clinical staff.

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

The change would waive requirements that nursing services be provided 24 hours a day and that a registered nurse be immediately available if needed for any patient receiving care on hospital premises.

CMS believes more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease can be treated for safely in home settings with proper monitoring and treatment protocols.

Six health systems have already received approval under the waiver program. Brigham and Women’s Hospital and Massachusetts General Hospital in Massachusetts, Huntsman Cancer Institute in Utah, Mount Sinai Health System in New York, Presbyterian Healthcare Services in New Mexico and UnityPoint Health in Iowa, all obtained approval Wednesday to start delivering at-home acute care services.

CMS said it expects more applications to be submitted after holding discussions with other health systems about the program.

The new program is separate from more traditional home health services in the sense that it will be only for patients who would otherwise be admitted as hospital inpatients and require daily monitoring by a physician and a medical team for their care needs on an ongoing basis.

CMS on Wednesday also revised its guidance for allowing same-day, ambulatory surgical centers to temporarily certify as hospitals and provide inpatient care for periods longer than 24 hours before being required to transfer patients to an acute-care hospital.

The update clarifies ambulatory surgical centers need only to provide 24-hour nursing services when one or more patients are on-site instead of having nurses be present even when no patients are in the facility in order to achieve hospital certification.

Such actions are in response to hospitals across the country reporting they are quickly running out of beds as a result of the latest surge in COVID-19.

More than 172,000 new cases in the U.S. were reported on Wednesday, according to Johns Hopkins Medicine’s Coronavirus Resource Center, for a total of more than 12.5 million since the beginning of the pandemic. More than 261,000 people have died from COVID-19, with more than 2,100 new deaths reported on Wednesday.


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