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Congress Eyes Expansion of Hospital at Home Care Model

Analysis  |  By Eric Wicklund  
   February 09, 2024

A new bill before Congress would create a pilot program to examine whether the Hospital at Home care model could be extended to other patient populations

Congress is wading into the question of whether the Hospital at Home model of care should be made permanent.

U.S. Senators Marco Rubio (R-Florida) and Tom Carper (D-Delaware) have introduced a bill that would set up a pilot program to test whether the Acute Hospital Care at Home initiative could be expanded to new populations beyond those needing acute care services.

The At Home Observation and Medical Evaluation (HOME) Services Act, if passed, would give the strategy some life beyond the planned December 31, 2024 expiration date for the Medicare waiver that supports the program.

“Addressing our healthcare challenges requires innovative solutions,” Rubio said in a joint press release issued yesterday. “The At HOME Services Act builds on the success of the hospital-at-home program to lower costs and burdens and improve patient outcomes and satisfaction.”

[See also: Patient Experience is Crucial to the Success of Hospital at Home.]

The bill adds a new wrinkle in the ongoing debate over whether the program should continue after this year.

The model targets patients who would otherwise be admitted to the hospital, creating a home-based care management plan that includes often-multiple daily visits by care teams, virtual care services and remote patient monitoring. Some programs have added ancillary services to address social determinants of health, imaging and tests, and pharmacy and rehab needs.

While acute care at home programs have been in existence in some form for several years, the Hospital at Home concept took off during the pandemic, when health systems and hospitals were struggling to keep up with the wave of new patients and were looking for ways to treat certain patients at home. The Centers for Medicare & Medicaid Services (CMS) established a waiver that enables Medicare reimbursement for health systems following the CMS model, which sets rigid guidelines for in-person visits and digital health and telehealth use. The waiver was due to end with the Public Health Emergency (PHE), but has been extended until the end of this year.

[See also: How Can Hospitals Turn the Home Into a Healthcare Hub?]

Supporters, including an advocacy group formed out of several of the more than 300 hospitals using the CMS model, are lobbying both CMS and Congress to make the Medicare waiver permanent, arguing that many programs would struggle or even shut down without Medicare support. They also point to a recent nationwide study that shows positive clinical outcomes in the Hospital at Home model.

On a related front, New Jersey recently passed a law that enables Garden State health systems to expand the Hospital at Home program to residents on Medicaid or NJ Family Care programs, as well as those on private insurance.

“We are excited to see Hospital at Home expand in New Jersey through this legislation, and we believe our state can serve as a template for the rest of the country,” Michael Capriotti, MBA, senior vice president of integration and strategic operations for New Jersey-based Virtua Health, told local media after the law went into effect. “It is important that we continually innovate to create the best possible experiences and outcomes for our patients.”

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


The Acute Hospital at Home concept gained significant traction during the pandemic, when health systems and hospitals sought new approaches to treat patients in their own homes rather than in a hospital.

More than 300 health systems are taking part in a national model supported by CMS through a waiver that enables hospitals to seek Medicare reimbursement. That waiver is scheduled to expire at the end of the year.

Supporters want the waiver to be made permanent, arguing that Hospital at Home programs have shown positive clinical outcomes and should be expanded to help other patients.

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