New Law: Hospital Action Required if Participating or Planning to Participate in Program
| To: | Chief Executive Officers, Chief Medical Officers, Chief Nursing Officers, Legal, Quality and Risk, and Government Affairs Staff |
| Staff Contact: | Katerina Lamarche, JD Policy Director katerinal@wsha.org | (206) 216-2505 |
| Subject: | Hospital at Home |
Purpose
The purpose of this bulletin is to provide hospitals information about SHB 2295, which allows for the continuation of hospital at home services and authorizes a regulatory structure for the Department of Health (DOH).
Applicability/Scope
Effective June 6, 2024, SHB 2295 applies to hospitals currently offering hospital at home services and hospitals interested in offering hospital at home services.
Recommendations
- Review this bulletin and SHB 2295 to learn more about hospital at home and requirements for providing services.
- If your hospital is interested in providing services, consider the timeline, notification, and waiver requirements.
- Engage in the rulemaking process by participating DOH stakeholder meetings and providing feedback to WSHA.
Overview
Hospital at Home is not home health. It is a care delivery model that allows a hospital to provide acute care services to patients in their homes or other location as an alternative to hospital admission.
SHB 2295 establishes hospital at home services as a hospital service line and authorizes a regulatory structure for the DOH to regulate those services. This will allow for the continuation of hospital at home services currently being provided by hospitals through the Center for Medicare and Medicaid Services (CMS) Acute Hospital Care at Home (AHCAH) waiver program. The bill also exempts hospital at home services from in-home services agency requirements, home health care and hospice requirements, and certificate of need review.
By December 31, 2025, the DOH must adopt rules to add hospital at home services to the services that an acute care hospital may provide. The rules will establish the standards for the provision of services. WSHA worked closely with legislators and the DOH to ensure that the standards established in rule adhere to the AHCAH waiver program requirements as closely as possible.
The DOH may set a one-time application fee by rule and the administration of the program will be covered by hospital licensing fees.
Timeline
June 6, 2024:
Hospitals that are not currently authorized to provide hospital at home services may apply for an AHCAH waiver and provide services under the CMS AHCAH waiver program. Hospitals with an AHCAH waiver that intend to provide hospital at home services must notify the DOH within 30 days of receiving the waiver.
December 31, 2024:
Federally, the CMS AHCAH waiver program is set to expire on December 31, 2024. If the program is not extended and expires on that date, hospitals must continue to follow AHCAH waiver program requirements that were in effect as of the date of the program’s expiration and the DOH must enforce the requirements until the DOH adopts rules.
December 31, 2025:
The DOH must adopt rules by December 31, 2025. Once rules are established, hospitals that intend to offer or continue offering hospital at home services must apply to the DOH for approval. Hospitals with an AHCAH waiver prior to rule adoption may provide hospital at home services while applying for approval. Hospitals that have not obtained an AHCAH waiver prior to rule adoption may not provide services until DOH approval.
Background
CMS introduced the AHCAH waiver program in November 2020 to help increase acute care bed capacity and relieve systemic stress due to COVID. The program waived certain nursing-related Medicare Conditions of Participation and authorized fee for service reimbursement at parity. This opened the door for hospitals to start their own programs and treat patients’ acute care conditions in their home.
The DOH was exercising enforcement discretion for Washington hospitals participating in the AHCAH waiver program during COVID. DOH indicated that enforcement discretion would be ending in June 2024, and that without legislative action, services could no longer be provided after that date. WSHA actively engaged with legislators and the DOH to support and draft SHB 2295.
Next Steps
The DOH will hold a rulemaking to add hospital at home services as a hospital service line and establish the standards for the provision of services.
WSHA’s New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2024 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
References
