House Votes to Extend Medicare Waivers for Hospital at Home Program
Overview of the Legislation
The House of Representatives has unanimously approved a bill to extend Medicare waivers for the hospital at home program for an additional five years. This decision extends the pandemic-era program, which previously faced a series of short-term renewals. Under the new legislation, certain requirements will be waived to allow hospitals to deliver acute inpatient care in patients’ homes until September 30, 2030. The waivers were initially set to expire on January 30, 2026.
Reactions from Stakeholders
The passage of the bill has been met with approval from hospital and telehealth organizations. Alexis Apple, director of federal affairs at ATA Action, the advocacy branch of the American Telemedicine Association, remarked, “This is a perfect example of how our government should work.” The bill is now pending a vote in the Senate.
Significance of the Extension
Support from Hospital Groups
Hospital organizations have actively lobbied for this legislation, which promises long-term funding security for hospital at home programs. While the concept of hospital at home has existed for decades, its implementation gained momentum during the pandemic, following the launch of the Acute Hospital Care at Home initiative by CMS. This program aimed to assist hospitals facing capacity challenges due to COVID-19 by waiving certain facility and nursing requirements and facilitating reimbursement for at-home acute care. Hospitals participating in the program are required to report patient safety data to the government.
Expansion and Benefits of the Program
The pandemic prompted major health systems, such as the Mayo Clinic, to initiate hospital at home programs. Additionally, new entrants like Best Buy also ventured into this space. By July, around 400 hospitals across more than 140 systems had received approval to offer hospital at home care, as reported by the American Hospital Association. Proponents argue that this program not only reduces costs but also alleviates space constraints in hospitals, enabling patients to receive care in their homes. Research indicates that patients tend to recover more effectively at home and have fewer instances of returning to facilities for additional care. A 2024 study by CMS highlighted that the program resulted in lower mortality rates and decreased costs following discharge compared to traditional hospital settings.
Challenges and Future Considerations
Previous Waiver Expiration and Extensions
Initially, the hospital at home waivers were set to end with the conclusion of the pandemic public health emergency in 2023. Congress has since extended these waivers multiple times in short-term increments. This year, the program faced expiration during a 43-day government shutdown, creating temporary capacity issues for hospitals. Following the reopening of the government, the waivers were extended until January 30, 2026.
Call for Longer Extensions
Hospital and telehealth advocates contend that a longer extension is essential for the program’s stability, encouraging new participants to launch their own hospital at home initiatives. The American Hospital Association emphasized in a September letter to a House subcommittee that establishing a hospital at home program requires significant logistical and technical effort, including time, staffing, and financial investment. They noted that some providers must also navigate additional state-level regulatory requirements, which can prolong the process by a year or more before they can treat their first patient at home.
Data Collection and Monitoring
In addition to extending the program through 2030, the new legislation mandates that CMS gather data on care quality, including metrics related to hospital readmissions, mortality rates, nurse staffing, and hospital transfers.