The
Acute Hospital Care at Home Program
On November 25, 2020, the Centers for Medicare
& Medicaid Services (CMS) announced an expansion of the Hospital Without Walls initiative to include the Acute Hospital
Care at Home program. The intent of this program is to increase hospital
capacity by allowing patients to be seen outside of a traditional hospital
setting, while also protecting patients to ensure that they are treated
appropriately and safely in home settings during the COVID-19 public health
emergency (PHE).
The Acute Hospital Care at Home program clearly
differentiates the delivery of acute hospital care at home from more
traditional home health services, which provides skilled nursing and other
skilled care services at a beneficiary’s home. In contrast, the Acute Hospital
Care at Home is for patients who require acute inpatient admission to a
hospital and require at least daily rounding by a physician and a medical team
monitoring their care needs on an ongoing basis. Acute hospital care at home
services provide health care to acutely ill patients in their homes by using
methods that include telehealth, remote monitoring, and regular in-person
visits by nurses.
Hospitals interested in participating in this
program must apply directly with CMS for the waiver at Acute Hospital Care at Home and submit the necessary information to ensure
they meet the program’s criteria to participate. CMS will closely monitor the
program to safeguard beneficiaries by requiring hospitals to report quality and
safety data to CMS on a frequency based on their prior experience with the
Hospital At Home model.
General acute care hospitals (GACH) are required
to coordinate with the California Department of Public Health (CDPH) to operate
under the state's emergency preparedness or pandemic plan during the PHE to
help meet surge needs in their community. Hospitals must meet state licensure
requirements for GACHs and receive program flexibility from CDPH for any
requirement that will be met using an alternative method as indicated under the
Program Flex heading. In addition to receiving approval from CMS, a hospital seeking to offer acute hospital
care at home services may not begin providing this service until it has also
received approval from CDPH.
Currently, CMS and CDPH have approved the following hospitals to offer acute hospital care at home services.
Tier 1 (more than 25)
- Adventist Health, Bakersfield
- Adventist Health, Ukiah
- Tier 2 (fewer than 25 people)
- Adventist Health, Glendale
- Adventist Health, Simi Valley
Medi-Cal will pay hospitals for acute inpatient
care in both fee-for-service (FFS) and managed care for Medi-Cal beneficiaries
who receive care under this program. Managed care plans (MCPs) must authorize
and reimburse hospitals providing inpatient acute care services at home through
the Acute Hospital Care at Home program at the same rate they would if the
services were provided in a traditional hospital setting. DHCS will reimburse FFS
care as if the services were provided in a traditional hospital setting,
following current payment authorization processes and reimbursement
methodologies.
For Medi-Cal-enrolled hospitals participating in
the program, MCPs are responsible for knowing each participating hospital’s
waiver authorities and for authorizing members to receive acute care inpatient
services at home as medically appropriate. MCPs are responsible for tracking
each hospital’s approved waiver. MCPs are also responsible for ensuring that
their subcontractors and network providers comply with all applicable state and
federal laws and regulations, contract requirements, and other DHCS guidance,
including APLs and Policy Letters. Each MCP must communicate these requirements
to all subcontractors and network providers.
Providers are encouraged to review All Facility Letter 20-90, published by CDPH, for program flexibility
requirements before providing Acute Hospital Care at Home services. DHCS will
publish additional information on the DHCS COVID-19 Response webpage and webpage for All Plan Letters in the future regarding program operations
and approved providers of Acute Hospital Care at Home services.
For additional COVID-19 information and
resources, we encourage you to view the following resources:
