Hospital-at-Home Coalition Seeks 5-Year Waiver Extension

A coalition representing Hospital-at-Home (HaH) programs is asking Congress for at least a 5-year extension of the Acute Hospital Care at Home waiver program (AHCaH) before its expiration at the end of 2024. 

Medicare created the AHCaH waiver at the height of the COVID-19 pandemic as part of a broad strategy to help alleviate hospital capacity issues. Prior to the implementation of the AHCaH waiver, approximately 20 HaH programs existed across the United States. After the waiver, more than 300 hospitals across 129 health systems in 37 states are operating under the waiver. That represents approximately 5 percent of all U.S. hospitals and 15 percent of academic medical centers. 

At this current trajectory, 1 in 6 hospitals will have HaH by 2030. Yet they have no guarantee of payment permanence. The letter to congressional leaders notes that without an extension, Medicare beneficiaries will lose access to HaH programs that have been demonstrated to provide excellent clinical outcomes and lower the costs of care.

The HaH stakeholders also said that clinical outcomes of the AHCaH program have been outstanding. Numerous studies have shown that patients and family caregivers prefer HaH, which delivers excellent clinical outcomes, including substantial reductions in adverse events (e.g., mortality), better patient and family experience, lower caregiver stress, better functional outcomes, high provider satisfaction, and lower costs of care. “As a result of these studies, we firmly believe that the AHCaH waiver, which provides appropriate payment for acute hospital-level care delivered at home, is the keystone to the future of home-based care delivery for Medicare patients and beyond,” the letter said. 

Moving Health Home (MHH), the group that wrote the letter, said that to achieve this future, the waiver must be extended to enable hospitals and health systems nationwide to continue building out the logistics, supply chain, and workforce for HaH and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market. “An extension will also allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs.”