Why this Matters
Revenue Impact: For some systems, Hospital-at-Home programs now account for millions in annual revenue. Pull the plug, and you’re staring at a not-so-cute cliff.
Workforce Flexibility: Virtual nursing, remote monitoring, and cross-state telehealth waivers tied into these flexibilities may get tangled in the expiration fallout.
Patient Expectation Shift: Once people realize they can avoid sharing a bathroom with a stranger down the hall, good luck convincing them to come back for a three-day observation stay.
Let’s talk about the elephant in the (living) room: the Acute Hospital Care at Home & Telehealth waivers are set to expire on September 30, 2025. If you haven’t already built a Plan B, you might soon be building a Plan “Oh No.”
These waivers, first granted during the pandemic, let hospitals provide acute level care in a patient’s home, complete with reimbursement. They gave us the freedom to turn patient’s bedrooms into ICU lite setups & taught us that sometimes the best “hospital food” is just dinner from the patient’s own kitchen.
But Washington doesn’t hand out permanent hall passes. The current extension is running out, and unless Congress or CMS intervenes (which, let’s be honest, is about as predictable as a toddler), the model could revert to pre-pandemic rules.
What’s Really Going on in DC?
CMS likes the model (it saves money and keeps patients happy), but cost data and safety outcomes are still under the microscope. Advocates are pushing for a permanent program, but Congress is juggling… well, everything else. The advocacy groups are loud, but not loud enough.
If history is any guide, last-minute extensions happen. But banking on that without a contingency plan? That’s a strategy called “hope,” and I don’t recommend it unless you’re also buying lottery tickets.
If You’re a Hospital Executive
Think of September 30, 2025, as a hard stop until proven otherwise.
Audit your program: Which patients, services, and staffing models are only possible because of the waiver?
Model the post-waiver P&L: Can you still operate profitably without current reimbursements? If not, what could you cut, consolidate, or renegotiate?
Get your lobby on: Partner with your state hospital association or a national advocacy group. Lawmakers need stories and numbers to act.
If You’re a Health-at-Home Startup
The window is closing for “waiver-dependent” pitches.
Future-proof your value proposition: Build out use cases that work under existing (non-waiver) regs—think chronic disease management, post-acute rehab, or bundled payment support.
Lock in provider contracts now: Systems are deciding which partners survive a waiver sunset. You want to be on the “keep” list.
Diversify your payer base: Commercial payers may be more open to continuing the model privately, even if Medicare pulls back.
My Take
The most successful health leaders in 2025 will be the ones who treat this like a certainty, not a cliffhanger. Design your strategy so that if the waiver survives, you win. If it dies, you still win. Everyone else will be caught scrambling, calling emergency board meetings, and panic-ordering sandwiches.
Bottom Line
Hospital-at-Home & telemedicine have moved from “pandemic experiment” to “patient preference.” Whether CMS makes it permanent or not, the genie is out of the bottle. And if you don’t have a plan for September 30, it’s time to stop reading newsletters (even this one) and start making a plan.
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