The California Department of Public Health (CDPH) and Department of Health Care Services (DHCS) have issued additional information and guidance for hospitals who are interested in participating in the Acute Hospital Care at Home (ACHAH) program. The Centers for Medicare and Medicaid Services (CMS) recently introduced a provider waiver for this program, expanding on their Hospital Without Walls waiver to provide regulatory flexibility for hospitals to treat patients in locations outside the hospital, including their homes.
CDPH has issued All facilities Letter (AFL) 20-90 which communicates that general acute care hospital (GACH) seeking to provide acute hospital care at home services must also meet applicable GACH licensing requirements and obtain approval for appropriate program flexibilities from CDPH. To apply for a program flexibility, a GACH must submit form CDPH 5000 (PDF) and supporting documentation to CDPH’s Centralized Program Flex Unit and the district office that oversees the facility for each regulation for which the hospital requests flexibility. Hospitals may not begin providing this service until it has received approval from CDPH.
DHCS has announced that Medi-Cal will reimburse participating hospitals for acute inpatient care in both fee-for-service and managed care for Medi-Cal beneficiaries. DHCS will reimburse fee-for-service care as if the services were provided in a traditional hospital setting, following current payment authorization processes and reimbursement methodologies. Managed care plans (MCPs) must authorize and reimburse hospitals providing inpatient acute care services at-home through the Acute Hospital Care at Home program at the same rate they would if the services were provided in a traditional hospital setting.