This Bulletin was updated on Dec.10, 2021, in SPECIAL BULLETIN COVID-19 #202: Extension of Hospital at Home Program.
This Bulletin is an update to SPECIAL BULLETIN COVID-19 #178: Temporary Provisions for COVID Surge: Post-Acute PA Exceptions and Hospital at Home Program.
Effective Sept. 1, 2021, the Acute Hospital Care at Home (HAH) program will be available to North Carolina hospitals that have been granted a waiver from CMS and service NC Medicaid beneficiaries. NC Medicaid is planning to implement this program to be effective Sept. 1 through Dec. 31, 2021, unless this flexibility is terminated prior to Dec. 31, 2021.
The Acute HAH program is an expansion of the CMS Hospital Without Walls initiative as a part of a comprehensive effort to increase hospital capacity, maximize resources and combat COVID-19 to keep Americans safe. This program creates additional flexibility that allows for certain health care services to be provided outside of a traditional hospital setting and within a patient’s home. CMS guidance for participation in this program can be found on the CMS Acute Hospital Care at Home webpage. Programs that have been granted a waiver by CMS should submit a copy of their CMS HAH waiver to our reimbursement team to qualify for reimbursement at Medicaid.ProviderReimbursement@dhhs.nc.gov.
- There are several requirements that a hospital must meet to participate in the HAH program. These include:
- Having appropriate screening protocols in place before care at home begins to assess both medical and non-medical factors.
- Having a physician or advanced practice provider evaluate each patient daily, either in person or remotely.
- Having a registered nurse evaluate each patient once daily, either in person or remotely.
- Having two in-person visits daily by either registered nurses or mobile integrated health paramedics, based on the patient’s nursing plan and hospital policies.
- Having the capability of immediate, on-demand remote audio connection with an Acute HAH team member who can immediately connect either an RN or MD to the patient.
- Having the ability to respond to a decompensating patient within 30 minutes.
- Tracking several patient safety metrics with weekly or monthly reporting, depending on the hospital’s prior experience level.
- Establishing a local safety committee to review patient safety data.
- Using an accepted patient leveling process to ensure that only patients requiring an acute level of care are treated.
- Providing or contracting for other services required during an inpatient hospitalization. It is important to note that patients will only be admitted to the program from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required prior to starting services at home.
Eligible hospitals will be reimbursed under the existing NC Medicaid inpatient hospital reimbursement methodology but will need to document the Condition Code of DR twice on their claim to identify patients who are “admitted to home.” All claims are subject to audit, and the double entry of the DR condition code is the flag that we will use to verify the location of service is at home. NC Medicaid will study and consider the experience of the HAH model of care during the pandemic to inform future policy direction. Standard Plans are permitted to require notification and review all HAH admissions for medical necessity.
NCTRACKS Contact Center: 800-688-6696