Acute Hospital Care at Home

To meet the standards of a qualifying Medicare claim for the Acute Hospital Care at Home program, facilities must have received a waiver from CMS.

CMS is accepting waiver requests to waive §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week, and the immediate availability of a registered nurse for care of any patient.

Waiver requests will be divided into 2 categories based on a hospital’s prior experience:

• Hospitals that have previously provided home acute hospital services to 25+ patients
• Hospitals that have either not provided home acute hospital services at all or have provided care to less than 25 patients

Please review the complete waiver criteria and process and the list of approved hospitals and health systems.

Please note: Each hospital certified to provide care to Medicare members has a unique CMS Certification Number (CCN). Each hospital seeking to provide Acute Hospital Care at Home must submit the waiver request under its unique CCN. For example, if a hospital system has 7 hospitals, but only 2 of the hospitals admit patients who use Acute Hospital Care at Home services, 2 separate waiver requests must be submitted.

Acute Hospital Care at Home services are a covered benefit in the following UnitedHealthcare benefit plans only:

• Medicare Advantage
• Medicare Advantage Special Needs plans, including Dual Eligible Special Needs (D-SNP)
• Group Medicare Advantage 
• Medicaid plans only if mandated by state law or regulations

The following UnitedHealthcare plans are out of scope for participation in the Acute Hospital Care at Home waiver program. Any claims for program services submitted for these plans may be denied:

• Individual and Family Plans
• Individual and Group Market plans
• Medicaid plans not mandated by state law or regulations

We will continue to accept qualifying claims for Acute Hospital Care at Home services provided to beneficiaries of these plans through Dec. 31, 2024, as outlined through the Consolidated Appropriations Act. Unless mandated by state regulations, members in Medicaid plans are ineligible for participation.

Please review the information below for details. If you have specific billing or claims questions, please contact your provider advocate or network engagement manager.

In addition to meeting all CMS requirements related to the Acute Hospital Care at Home program, qualifying claims must also meet the following UnitedHealthcare criteria:

• Have an in-network Participation Agreement (contract) with UnitedHealthcare for 1 or more of the in-scope benefit plans noted above
• Provide evidence-based criteria for inpatient care
• Notify us immediately when:
  • An applicable member is admitted to the Acute Hospital Care at Home program; or
  • A member in the program is transferred back to inpatient care facility or has any other status change in their care plan; and
  • Notification can be made through the UnitedHealthcare Provider Portal, phone intake or through the utilization management nurse assigned to the Acute Hospital Care at Home case
• For services provided on or after Aug. 1, 2022, submit claims using the approved Hospital at Home revenue codes for services provided:
  • Occurrence Span Code 82
    • Title: Hospital at Home Span Code 82 Care Dates 
    • Definition: The from/through dates of a period of hospital at home care provided during an inpatient hospital stay 
  • Revenue Code 0161
    • Subcategory Definition: Room & Board – Hospital at Home 
    • Standard Abbreviation: R&B/Hospital at Home 

Please note:

• All Acute Hospital Care at Home claims are subject to the UnitedHealthcare standard utilization management process
• UnitedHealthcare does not cover Acute Hospital Care at Home services provided by non-contracted facilities
• Observation stays are not eligible for Acute Hospital Care at Home, are not covered by UnitedHealthcare and will not be reimbursed
• Payment for Acute Hospital Care at Home claims will be handled in accordance with terms in the health care professional’s Participation Agreement with UnitedHealthcare
• If a claim is denied, network (contracted) providers may not bill the member for any Acute Hospital Care at Home-related charges. If you disagree with the claim denial, you may ask UnitedHealthcare to review the denial using the reconsideration and appeal process outlined in your Participation Agreement and in the Provider Administrative Guide.
• We’ll continue to update billing guidance on this page, as necessary, and alert health care professionals when updates are made