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As urged by the AHA, the Centers for Medicare & Medicaid Services today gave hospitals facing a surge in COVID-19 patients expanded flexibility to care for Medicare patients outside their walls. The expands on the successful Hospital Without Walls program authorized in March to support additional models proven to provide effective hospital care at home.

According to CMS, the new program will require an in-person physician evaluation and screening protocols to assess medical and non-medical factors before care at home begins, with beneficiaries admitted only from emergency departments and inpatient hospital beds. A registered nurse will evaluate each patient once daily in person or remotely, and either registered nurses or mobile integrated health paramedics will conduct two in-person visits daily based on the patient’s nursing plan and hospital policies. Hospitals also will report quality and safety data to CMS at a frequency based on their prior experience with the Hospital At Home model.

CMS today approved waivers for six health systems with extensive experience providing acute hospital care at home to immediately participate: Brigham and Women’s Hospital and Massachusetts General Hospital in Massachusetts; Huntsman Cancer Institute in Utah; Mount Sinai Health System in New York; Presbyterian Healthcare Services in New Mexico; and UnityPoint Health in Iowa. Other hospitals and health systems may submit a .

AHA last month urged CMS to continue the Hospital Without Walls flexibilities to the greatest extent possible, saying the waivers have had “a profoundly positive effect on hospitals’ abilities to manage the pandemic.”

In related news, CMS clarified today that ambulatory surgical centers participating in the Hospital Without Walls program need only provide 24-hour nursing services when they have one or more patients receiving care onsite.