A new law allows Garden State health systems to expand their Hospital at Home programs to include Medicaid patients and those on private insurance
Health systems in New Jersey are now able to expand their Hospital at Home programs to patients in Medicaid and private insurance, thanks to a new state law.
The Hospital at Home Act, which was passed by the state Legislature and signed by Governor Phil Murphy in September 2023 and enacted into law on January 23, establishes a state Hospital at Home permitting process through the New Jersey Department of Health that is consistent with the Centers for Medicare & Medicaid Services’ Acute Hospital Care at Home Program.
Executives at Virtua Health, which launched its Hospital at Home program two years ago and now offers services through five of its hospitals in the southern part of the state, hailed the new law. Aside from introducing patients in the state’s NJ Family Care and Medicaid programs to the service, the law enables the health system to work with private payers to cover the program.
“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 Virtua Health, told the Gloucester City News earlier this week. “It is important that we continually innovate to create the best possible experiences and outcomes for our patients.”
More than 300 health systems and hospitals across the country are following the guidelines set by the CMS program, which includes a waiver, put in place during the pandemic in 2020, that allows the healthcare organization to qualify for Medicare reimbursement. That waiver is due to expire at the end of this year, and supporters are lobbying both Congress and CMS to make that waiver permanent.
The program 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.
New Jersey is one of the first state to establish specific state guidelines for the program.
According to Virtua Health, the health system has enrolled more than 900 patients, representing more than 60 different medical conditions, in the program.
According to a recent national study of the program by researchers at Mass General Brigham—one of the first health systems to launch the program—the Hospital at Home concept has reduced the mortality rate for patient who would otherwise be hospitalized; it has also reduced the escalation rate (returning to the hospital for at least 24 hours) and rehospitalization rate within 30 days of discharge.
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, said in a press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.
The CMS Acute Hospital Care at Home program enables health systems and hospitals to create a care management plan for patients at home who would otherwise be hospitalized. The program is supported by a waiver that allows hospitals to be reimbursed through Medicare for those services.
New Jersey has passed a state law that expands the program through the state Department of Health to NJ Family Care and Medicaid members and those on private insurance.
The CMS waiver is due to expire at the end of the year, affecting more than 300 health systems and hospitals across the country, and supporters are lobbying to make that waiver permanent.