H.R. 8923: At Home Observation and Medical Evaluation Services Act of 2026

This bill, known as the "At Home Observation and Medical Evaluation Services Act of 2026," aims to create a two-year demonstration program allowing hospitals to provide outpatient observation services to Medicare beneficiaries in their homes. Below are the key points outlining what the bill intends to accomplish:

Establishment of a Demonstration Program

The bill mandates the Secretary of Health and Human Services to implement a program within one year of its enactment, focusing on providing outpatient observation services to eligible Medicare beneficiaries in their homes. This program is intended to last for two years.

Waivers and Flexibilities

To facilitate this program, hospitals may apply for specific waivers and flexibilities, including:

• Waiver of the requirement for 24-hour nursing services on the hospital premises.
• Waiver of immediate availability of a registered nurse, which is typically required for hospital care.
• Waiver of certain telehealth requirements, allowing beneficiaries to receive services at home.

Criteria for Hospital Participation

Hospitals wanting to participate in the program must meet specified criteria, such as:

• Ensuring the standard of care at home matches that of care received in a hospital.
• Complying with patient safety standards set by the Secretary.
• Providing data necessary for monitoring care quality and safety as well as analyzing costs associated with home care versus hospital care.

Termination of Participation

The Secretary has the authority to terminate a hospital's participation in the program if it is determined that the hospital no longer meets the established criteria.

Study and Reporting

The bill requires a study to be conducted during the demonstration program, which will analyze:

• The criteria hospitals use to determine which beneficiaries receive services.
• The quality of care between in-hospital services and those provided at home.
• Costs associated with care in both settings.
• Patient outcomes, such as readmission rates and patient experiences.

A report summarizing the findings of the study must be published on the Centers for Medicare & Medicaid Services (CMS) website within one year of completing the program.

Implementation

The Secretary is authorized to implement this program through various means, including program instructions.

Public Information

The information collected from the program will be made publicly available on the Medicare.gov website or a similar platform, enhancing transparency regarding the outcomes of the demonstration program.

Relevant Companies

• HCA Healthcare (HCA) - This company operates numerous hospitals and healthcare services and could be significantly impacted by the program as it may change how outpatient observations are approached and reimbursed.
• UnitedHealth Group (UNH) - As a major managed health care company, UnitedHealth may be affected by the shift toward home-based outpatient services, influencing how they manage Medicare plans.