Covid-19 Waivers Extended Again
On March 15, President Trump signed a continuing resolution passed by Congress extending COVID-19-era Centers for Medicare and Medicaid Services regulations for telehealth and hospital-at-home through September 30, 2025. This recent extension is just one of several months-long continuations, leaving healthcare organizations simultaneously relieved and frustrated about their limited ability to plan for the future.
For telehealth, the continuing resolution extends critical flexibilities including:
- Removal of geographic boundaries
- Expansion of telehealth service originating locations (including patients’ homes)
- Permission for more providers and services to receive telehealth reimbursement
- Allowance for audio-only visits
- Removal of requirements for initial in-person behavioral health visits
- Extension of telehealth services for Federally Qualified Health Centers and Rural Health Clinics
The hospital-at-home waiver extension, formally known as the Acute Hospital Care at Home initiative (AHCAH), enables full Diagnosis Related Group-based reimbursement for Medicare patients receiving hospital-level care in their homes.
Bipartisan Support Yet Uncertain Future
While waiver extensions for both telehealth and hospital-at-home have bipartisan support, healthcare executives remain deeply concerned that the tangible benefits of each initiative will be lost or not fully realized without a long-term solution. This ongoing uncertainty limits appetite for the meaningful investments required to scale these initiatives and make them permanent parts of health systems’ care delivery ecosystems.
Hospital-at-home programs maintain optimism for further extension of the CMS waiver because:
- The program is cost-neutral or even favorable to CMS
- There is strong bipartisan support
- Providers and researchers have built a positive narrative that resonates with policymakers
Similar support exists for telehealth, with advocacy across the political spectrum and highly favorable patient experiences. The primary challenge is the significant costs associated with expanded reimbursement provisions, which may result in eliminating specific program elements in today’s political environment.
Current Adoption And Planning Challenges
“As of March 17, 2025, 400 hospitals within 143 health systems across 39 states have been granted AHCAH waivers by CMS,” reported Jon Freedman, partner at Chartis. “This includes more than 20 hospitals being granted waivers in 2025. So, for hospital-at-home, there has been and still is substantial interest from a broad swath of providers.”
For providers without established hospital-at-home programs, this uncertainty means they’re unlikely to invest substantially at this stage. Many are using this time to build business cases and deeply evaluate the economic, clinical, operational, technical, and cultural implications of launching a program.
Even without CMS reimbursement, many hospital systems may find substantial economic benefits to hospital-at-home programs. Providers with existing programs fall into different maturity categories:
- Mature programs: Those realizing returns on investment with improved care quality and patient experience are likely to continue investing. While they risk revenue loss if Medicare reimbursement ends, the value derived from maintaining and expanding their programs outweighs that risk.
- Less mature programs: Systems with an average daily census under 15 are generally in wait-and-see mode, refreshing their business cases and strategies that may have been haphazardly implemented during COVID when urgency drove decisions more than strategy.
Impacts On Healthcare Stakeholders
Payers and vendors for hospital-at-home services and technology are patiently waiting to act. Commercial payers recognize the appeal of lower-cost models but hesitate to invest substantially until the regulatory environment stabilizes. Similarly, technology vendors are maintaining existing products but may not invest in new capabilities until market positioning clarifies.
For telehealth, providers, payers, and technology vendors are developing contingency plans if waiver extensions are discontinued, even partially. The challenge grows with each extension as telehealth becomes more deeply embedded in care models:
- Patients increasingly rely on and demand versatile engagement with providers
- Providers have incorporated telehealth into their operations
- Vendors have built out capabilities and services
- Payers have incorporated telehealth into risk-based arrangements and direct consumer services to lower care costs
Without extended flexibilities, care supply will again be limited. FQHCs and RHCs will face particular restrictions, affecting their ability to provide equitable care and meet unmet needs. Behavioral health services, which have benefited significantly from telehealth advancements, will be especially impacted if requirements for initial in-person visits are reinstated.
Economic And Non-Economic Benefits
Hospital-at-home benefits fall into two main categories: direct economic benefits and non-economic benefits.
Economic benefits include:
- Relief of capacity constraints and backfill with higher-acuity patients
- Capital avoidance (creating capacity at lower costs than the $2-4 million per hospital bed)
- Stand-alone profitability (assuming CMS reimbursement at parity and reasonable commercial reimbursement)
Non-economic benefits include:
- Improved patient care (studies show hospital-at-home is safe and effective)
- High patient and family caregiver satisfaction
- High clinician satisfaction and reduced burnout
- Attraction of experienced talent, particularly in nursing
- Tangible example of care model transformation
Leaders And Laggards In Home-Based Care
Health systems with established hospital-at-home programs (average daily census of 15-20 patients) are achieving cash flow positivity and realizing many benefits: improved bed capacity, high-quality patient care, and innovative care delivery. Many are expanding their foundation to other care-at-home models, including observation, emergency services, post-acute care, and chronic condition management.
Leading systems like Mass General Brigham and Advocate, with average daily census figures of 60 and 100 respectively, are paving the way for others through robust business cases and execution.
Less mature health systems face several obstacles:
- Lack of comprehensive business cases and strategic implementation
- Insufficient dedicated personnel and unclear objectives
- Limited focus on selected conditions rather than broader patient populations
- Organizational culture challenges
Future Of Home-Based Healthcare
The hospital-at-home movement is at an inflection point. Research data strongly supports the model’s viability, suggesting a need for mainstream adoption rather than perpetual pilot programs.
For broader adoption, several actions would help:
- Long-term extension of CMS waivers, including permanent provisions
- Commercial payer reimbursement frameworks for both fee-for-service and risk-based models
- Logistics management improvements to address the complexity of providing acute care in homes
- Operational refinements, such as allowing direct admission from locations beyond emergency departments
With these changes, hospital-at-home and broader telehealth services could transform healthcare delivery, helping systems better serve their communities despite capacity constraints and demographic challenges.
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