Last update: October 8, 2021, 8:30 a.m. CT
Effective Nov. 1, 2021, UnitedHealthcare is accepting the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home program waiver for qualifying Medicare claims. Our goal is to help more members receive care at a time when many hospitals are overburdened. We will accept the waiver from Nov. 1, 2021 through the last day of the COVID-19 national public health emergency period, when it is announced.
Please review the information below for details. If you have specific billing or claims questions, please contact your Provider Advocate or Network Engagement Manager.
The CMS Acute Hospital Care at Home program was designed to increase hospital capacity and improve resource allocation during the COVID-19 national public health emergency. It is an expansion of the Hospitals Without Walls program, which allowed hospitals to provide services in locations beyond existing facilities.
As part of Acute Hospital Care at Home, in November 2020 CMS waived a previous Medicare Conditions of Participation requirement. The waiver allows qualifying hospitals to receive inpatient payment for providing acute-level services to Medicare beneficiaries in their homes.
Additional information on the program is available at the CMS website.
CMS is 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.
Waiver requests will be divided into 2 categories based on a hospital’s prior experience:
As of early October 2021, 177 hospitals and 77 health systems in 33 states had received CMS approval to participate in the Acute Hospital Care at Home program. Please review the complete waiver criteria and process and the list of approved hospitals and health systems.
Please note: Each hospital certified to provide care to Medicare patients has a unique CMS Certification Number (CCN). Each hospital seeking to provide Acute Hospital Care at Home must submit the waiver request under its unique CCN. For example, if a hospital system has 7 hospitals, but only 2 of the hospitals admit patients who use Acute Hospital Care at Home services, 2 separate waiver requests must be submitted.
UnitedHealthcare will accept qualifying claims for Acute Hospital Care at Home services provided to Medicare Advantage beneficiaries on or after Nov. 1, 2021. We will accept these qualifying claims for the duration of the national public health emergency. Unless mandated by state regulations, members in Medicaid plans are ineligible for participation.
CMS requirements
To meet the standards of a qualifying Medicare claim for the Acute Hospital Care at Home program, facilities must have received a waiver from CMS.
UnitedHealthcare requirements
The following UnitedHealthcare benefit plans are in scope for participation in Acute Hospital Care at Home:
The following UnitedHealthcare plans are out of scope for participation in Acute Hospital Care at Home:
In addition to meeting all CMS requirements related to the Acute Hospital Care at Home program, qualifying claims must also meet the following UnitedHealthcare criteria:
Please note:
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.