clinician examining patient at home

An alliance of healthcare providers called on the Biden administration to tear down barriers to expanding clinical care into the home. 

In a letter to the president last week, Moving Health Home urged the administration to make a commitment to clinical care in the home in its 2024 budget that goes beyond Medicaid home- and community-based services. The group called HCBS “the tip of the spear” in what is possible for in-home medical care, such as hospital-at-home and skilled nursing facility-at-home.

“We ask that you work to remove regulatory barriers to ensure all patients may choose to receive clinical care in the home and take advantage of the convenient, high-quality care that comes when patients receive home-based care,” the letter stated. “Importantly, we believe that care in the home contributes to health equity by giving historically disenfranchised populations the option to receive care on their own terms.”

The alliance called on the Biden administration to advance in-home care in a variety of ways:

  1. Reiterate support for the Centers for Medicare and Medicaid Services (CMS) Acute Hospital Care at Home Program, which allows patients to receive hospital-level care at home.
  2. Commit to skilled nursing facility (SNF) at home models of care.
  3. Direct CMS to reimburse home-based providers at parity with facility-based providers to allow equal access to care in the home.
  4. Encourage home-based care in Medicare Advantage through network adequacy standards using current authority to better incentivize clinical care in the home by going beyond existing standards.
  5. Request that CMS reconsider policy to allow for acute kidney injury patients to receive hemodialysis or peritoneal dialysis at home, when medically appropriate and preferred by the patient.
  6. Ensure home is an option for care in traditional Medicare, which favors facility-based care. 

During the COVID-19 pandemic CMS allowed greater flexibility in delivering care to patients outside the confines of medical facilities. While some flexibilities will expire at the end of the public health emergency in May, others have been extended. The omnibus bill the president signed at the end of last year extends CMS’ Acute Care at Home waiver program and some telehealth services until the end of 2024. 

Legislation that would have increased consumer access to in-home care, including the Choose Home Care Act of 2021, stalled in Congress. Recently, Democrat lawmakers reintroduced the Better Care Better Jobs Act, which would increase Medicaid HCBS funding for home-based care to seniors and people with disabilities.