Hospital At Home Lapse Sows Uncertainty Despite 60-Day Non-Enforcement Policy

SAN DIEGO -- Even though CMS has signaled it won’t issue citations for 60 days to hospitals continuing to provide at-home care to patients admitted to the Acute Hospital Care at Home (AHCAH) program before the program’s lapse on Oct. 1, some hospitals are still unwilling to serve patients unless they get a firmer commitment from the agency, according to the Bipartisan Policy Center (BPC).

“Some hospitals are unwilling to take the risk because a citation could hurt their hospital standings,” Allison Buffett, a senior policy analyst at BPC, wrote in a Monday (Oct. 6) blog post.

Moreover, many hospitals had already transferred AHCAH program patients to in-person care or discharged them in anticipation of the Oct. 1 lapse, according to Buffett and providers who have spoken to Inside Health Policy. This fact means it’s unclear what CMS’ 60-day non-enforcement policy will practically mean for hospitals, Buffett said.

Buffett wrote that some hospitals also want CMS to provide more clarification about the non-enforcement period. However, CMS furloughs tied to the ongoing government shutdown make it difficult for CMS to publish additional guidance or clarification, Buffett and sources in communication with the agency added.

CMS did not respond to a request for comment on the 60-day non-enforcement policy.

CMS has not officially announced the policy and has instead issued vague guidance stating:

“During a potential lapse in government funding and authorization of this waiver, if a hospital is found to be out of compliance with the Physical Environment condition of participation (including Acute Hospital @ Home waivers that will no longer be waived), CMS -- after receiving the survey -- would make the hospital’s compliance with this requirement part of a “plan of correction.” (See 42 C.F.R. 488.28(a)) Typically, hospitals have 60 days to respond to CMS with an acceptable plan of correction.”

The current regulatory chaos for the AHCAH program is refueling calls for Congress to extend the AHCAH program for five years.

“Hopefully, when Congress comes back, they'll reauthorize it, either through the CR or hopefully for another five years with a more robust evaluation,” said Lee Fleisher, CEO of Rubrum Advising, at the AdvaMed MedTech Conference.

A five-year extension of the AHCAH program has long been endorsed by the BPC, ATA Action, Moving Health Home, American Hospital Association and other stakeholders.

But Fleisher and other panelists who spoke at the AdvaMed MedTech Conference shared ways policymakers could rethink AHCAH program rules in addition to extending the program.

Fleisher said he has suggested to Rep. Dwight Evans (D-PA)’s office that the AHCAH program could change to allow for hospitals to participate if they can respond to patients within an hour of an emergency. Those patients, however, should have “proper monitoring like some form of continuous monitoring,” he added.

Current CMS policy requires participating hospitals to be able to respond within 30 minutes of an emergency.

Marybeth McMahon, director of operations for ChristianaCare, said updating this 30-minute rule would allow hospitals to expand the AHCAH program to rural areas.

Maulik Majmudar, chief medical officer of Biofourmis, wondered whether there’s a way for policymakers to dynamically change the 30-minute rule based on the severity of patients’ conditions.

McMahon said policymakers and industry alike should think about what data hospitals should collect from remote monitoring devices.

Majmudar added that how this data is interpreted and what amount of time during which data collection ceases is acceptable are other key questions for the AHCAH program. -- Christian Robles (crobles@iwpnews.com)