New Jersey Expands Hospital at Home Program
Providing medical care in a patient’s home has become increasingly popular with both providers and patients since the COVID-19 pandemic. Stevens & Lee previously blogged about the CMS Acute Hospital Care at Home Individual Waiver (the “Waiver”), which allows hospitals to provide care to certain patients in their homes. Earlier this year, New Jersey passed legislation to expand this program.
New Jersey Hospital at Home Program
To enable hospitals to treat patients within the comfort of their own homes, CMS’ Acute Hospital Care at Home initiative waives certain Conditions of Participation requirements applicable to acute care hospitals so hospitals can treat certain patients in their homes. This Waiver currently only applies to Medicare reimbursement, but New Jersey’s Hospital at Home Act (the “Act”) requires that payment additionally be made by private payors NJ FamilyCare and Medicaid. Under the Act, any hospital that is or has been issued a Waiver may participate in New Jersey’s Hospital at Home Program and, for private payors, reimbursement payments are established pursuant to the contract between the payor and the hospital. The Act also requires that all health care providers providing acute care services to patients outside of the hospital’s licensed space and within a private residence be credentialed by the payor as a condition of the services being considered “in network.” The Act runs concurrently with the Waiver program, which is set to expire on Dec. 31, 2024, absent an extension by Congress. A bill, the “Hospital Inpatient Services Modernization Act,” proposes to extend the Waiver program for an additional five years.
As of Nov. 6, 2024, 373 hospitals across 139 health systems in 39 states have an approved Waiver, with Holy Name Medical Center, Cooper University Hospital, Virtua Health hospitals, Hackensack Meridian Health hospitals, Salem Medical Center, Jefferson Health Cherry Hill Hospital, CareWell Health Medical Center and Inspira Health all participating from New Jersey.
CMS Hospital at Home Program
CMS conducted a study and released a report on its Waiver program. The study evaluated several aspects of the Waiver program and CMS provided a summary of its findings. Interestingly, with respect to Medicare beneficiary demographic characteristics, Waiver program patients were found to be meaningfully different from inpatients at the same hospital and Waiver program patients were found to be primarily treated for a relatively small set of conditions. These findings could be attributed to the policies and procedures that the hospitals participating in the Waiver program implemented to ensure that only appropriate patients were referred to receive treatment at home, such as requiring health care providers to consider a patient’s presenting symptoms and diagnosis and whether or not the patient could be effectively treated in his or her home, and if the patient’s home was suitable for the provision of acute care. The study also found that patients treated under the Waiver program had lower mortality and hospital-acquired conditions rates than those receiving care in a hospital.
However, the study had mixed results when comparing 30-day readmission rates of Waiver patients and patients treated in a hospital. Per the study, while patients in the Waiver program had a slightly longer length of stay than their in-hospital patient counterparts, the Medicare spending for services 30 days post-discharge for Waiver patients was lower, although the differences may be attributed to the types of patients selected for the Waiver program. Both patients and caregivers participating in the Waiver program reported positively on their experience to CMS, similar to the feedback health care providers also reported to CMS regarding their experiences with the Waiver program.
As noted above, providers participating in the Waiver program generally support hospital at home programs and some are pushing to expand these programs. The deadline for extension is fast approaching and the Hospital Inpatient Services Modernization Act is still sitting with the House Ways and Means Committee. Without an extension, the CMS Waiver Program and Act will sunset preventing Medicare, New Jersey Medicaid and New Jersey private payors from reimbursing for acute care services provided in patients’ homes. As discussed in our previous blog, health systems are finding creative solutions to implementing these programs outside of the CMS Waiver, and it appears that home-based health care will remain a popular format for delivering medical services.
