HR4313-119

What This Bill Does

The Hospital Inpatient Services Modernization Act keeps the Medicare Acute Hospital Care at Home initiative alive for several more years. It amends Social Security Act section 1866G to extend the waiver flexibilities from January 30, 2026, to September 30, 2030. Those waivers allow participating hospitals to furnish hospital-level services in a patient's home when the patient can safely receive that care outside a brick-and-mortar inpatient unit.

The bill also requires a new HHS study and report by September 30, 2028. The Secretary must examine hospital criteria for deciding which patients may receive acute care at home and must compare quality, readmissions, mortality, length of stay, infection rates, staffing mix, nurse ratios, home-to-hospital transfers, discharges to post-acute care, patient and caregiver experience, diagnoses, costs, service intensity, virtual contacts, family involvement, race and ethnicity, income, housing, geographic proximity to hospitals, dual Medicare-Medicaid eligibility, and emergency department versus inpatient-stay entry paths. The study must compare participating patients with nonparticipating patients while controlling for selection bias where practicable. The bill appropriates $2,500,000 to the CMS Program Management Account for fiscal year 2026 for the study and reduces the Medicare Improvement Fund from $1,403,000,000 to $1,400,500,000.

Who Benefits and How

Hospitals participating in Acute Hospital Care at Home benefit because the waiver runway extends to 2030 instead of expiring in early 2026. Medicare beneficiaries eligible for hospital-at-home care benefit from continued access to home-based inpatient-level services when clinical criteria are met. Home health service providers, remote patient monitoring companies, telehealth companies, medical equipment suppliers, and care-at-home logistics vendors benefit from continued demand from participating hospitals. CMS and congressional Medicare committees benefit from a detailed evidence base on whether the model reduces costs or changes outcomes compared with traditional inpatient care.

Who Bears the Burden and How

The Department of Health and Human Services, Centers for Medicare and Medicaid Services, participating hospitals, hospital data-reporting teams, caregivers asked to support home-based care, and healthcare policy researchers must gather data, comply with survey or cost-report submission requests, analyze patient-selection criteria, compare costs and outcomes, and report findings by September 30, 2028. The Medicare Improvement Fund loses $2,500,000 in budget authority to offset the CMS study appropriation.

Key Provisions

• Extends Acute Hospital Care at Home waiver flexibilities to September 30, 2030.
• Requires HHS to study patient-selection criteria used by participating hospitals.
• Requires comparison of quality, readmissions, mortality, length of stay, infection rates, staffing mix, transfers, discharges, patient experience, costs, and service intensity.
• Requires HHS to account for socioeconomic data, dual eligibility, housing, geography, and emergency department versus inpatient entry paths.
• Appropriates $2,500,000 to the CMS Program Management Account for fiscal year 2026.
• Reduces the Medicare Improvement Fund by $2,500,000.