Acute Hospital Care at Home

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:

• Hospitals that have previously provided home acute hospital services to 25+ patients
• Hospitals that have either not provided home acute hospital services at all or have provided care to less than 25 patients

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:

• Medicare Advantage
• Medicare Advantage Special Needs plans, including Dual Eligible Special Needs (DSNP)
• Group Medicare Advantage 
• Medicaid plans only where mandated by state law or regulations (currently Michigan, North Carolina and Ohio)

The following UnitedHealthcare plans are out of scope for participation in Acute Hospital Care at Home:

• Individual Exchange
• Individual and Group Market
• Medicaid plans not mandated by state law or regulations

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:

• Have an in-network Participation Agreement (contract) with UnitedHealthcare for 1 or more of the in-scope benefit plans noted above
• Provide evidence-based criteria for inpatient care
• Notify us immediately when:
  • An applicable member is admitted to the Acute Hospital Care at Home program
  • A member in the program is transferred back to inpatient care or has any other status change in their care plan
  • Notification can be made through the Provider Portal, phone intake or through the utilization management nurse assigned to the Acute Hospital Care at Home case

Please note:

• All Acute Hospital Care at Home claims are subject to the UnitedHealthcare standard utilization management process
• Acute Hospital Care at Home is not available for non-contracted facilities
• Observation stays are not eligible for Acute Hospital Care at Home and will not be reimbursed
• Payment for Acute Hospital Care at Home claims will be handled in accordance with terms in the health care professional’s Participation Agreement with UnitedHealthcare
• If a claim is denied, network (contracted) providers may not bill the member for any Acute Hospital Care at Home-related charges. If you disagree with the claim denial, you may ask UnitedHealthcare to review the denial using the reconsideration and appeal process outlined in your Participation Agreement and in the provider administrative guide
• We’ll continue to update billing guidance on this page as necessary and will alert health care professionals when updates are made