Originally authorized in the Affordable Care Act, the Independence at Home Model Demonstration tests the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. Primary care practices provide home-based primary care to targeted chronically ill beneficiaries. Participating practices make in-home visits tailored to an individual patient’s needs and coordinate their care. CMS will track the beneficiary’s care experience through quality measures. Practices that succeed in meeting these quality measures while generating Medicare savings will have an opportunity to receive incentive payments after meeting a minimum savings requirement. Originally launched in 2011, the performance period for the Independence at Home Model Demonstration has been extended twice by Congress and is now scheduled to end on December 31, 2023.
CMS has also announced several waivers of existing regulations to facilitate hospital-based care in the home during the COVID-19 pandemic.
Hospital Without Walls Blanket Waiver
In March 2020, CMS announced the Hospital Without Walls program, which provides broad regulatory flexibility for hospitals to provide services in locations beyond their existing walls. Under this initiative, CMS waived several Medicare Conditions of Participation at 42 CFR Part 482 and provider-based rules at 42 CFR §413.65 on a national basis. These so-called “blanket” waivers give hospitals flexibilities to respond to the COVID-19 PHE and to furnish care in alternative care sites, including retrofitted locations such as tents, gymnasiums, and the patient’s home.
Acute Hospital Care at Home Individual Waiver
CMS is also accepting waiver requests to waive §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient.