H.R. 8923

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8923 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8923

To amend title XVIII of the Social Security Act to establish a 2-year 
demonstration program for hospitals to provide outpatient observation 
services to Medicare beneficiaries at home.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

May 20, 2026

Ms. Castor of Florida (for herself and Mr. Buchanan) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
committee concerned

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to establish a 2-year 
demonstration program for hospitals to provide outpatient observation 
services to Medicare beneficiaries at home.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``At Home Observation and Medical 
Evaluation Services Act of 2026'' or the ``At HOME Services Act''.

SEC. 2. DEMONSTRATION PROGRAM FOR HOSPITALS TO PROVIDE OUTPATIENT 
OBSERVATION SERVICES TO MEDICARE BENEFICIARIES AT HOME.

Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866G the following new section:

``SEC. 1866H. DEMONSTRATION PROGRAM FOR HOSPITALS TO PROVIDE OUTPATIENT 
OBSERVATION SERVICES AT HOME.

``(a) In General.--Not later than 1 year after the date of 
enactment of this section, the Secretary shall implement a 2-year 
demonstration program (in this section referred to as the `Program') 
for hospitals to provide outpatient observation services to eligible 
beneficiaries in the homes of such beneficiaries. In implementing such 
Program, the Secretary shall grant waivers and flexibilities (as 
described in subsection (b)) to an individual hospital that submits a 
request for such waivers and flexibilities and meets specified criteria 
(as described in subsection (c)) in order to participate in the 
Program.
``(b) Waivers and Flexibilities.--For the purposes of subsection 
(a), the waivers and flexibilities described in this paragraph are the 
following waivers and flexibilities that are made available to 
individual hospitals under the Acute Hospital Care at Home initiative 
of the Secretary during the period described in section 1866G(a)(1):
``(1) Subject to subsection (c)(2), waiver of the 
requirements to provide 24-hour nursing services on premises 
and for the immediate availability of a registered nurse under 
section 482.23(b) of title 42, Code of Federal Regulations (or 
any successor regulation), and the waivers of the physical 
environment and Life Safety Code requirements under section 
482.41 of title 42, Code of Federal Regulations (or any 
successor regulation).
``(2) Waiver of the telehealth requirements under clause 
(i) of section 1834(m)(4)(C), as amended by section 4113(a) of 
the Health Extenders, Improving Access to Medicare, Medicaid, 
and CHIP, and Strengthening Public Health Act of 2022, such 
that the originating sites described in clause (ii) of such 
section shall include the home or temporary residence of the 
individual.
``(3) Other waivers and flexibilities that, as of the date 
of enactment of this section, were in place for such initiative 
during such emergency period.
``(c) Specified Criteria.--For purposes of subsection (a), the 
specified criteria for granting such waivers and flexibilities to 
individual hospitals are:
``(1) The hospital and any other entities providing 
services under arrangements with the hospital shall ensure that 
the standard of care to treat an eligible beneficiary at home 
is the same as the standard of care to treat such beneficiary 
as an inpatient of the hospital.
``(2) The hospital shall meet all patient safety standards 
determined appropriate by the Secretary, in addition to those 
that otherwise apply to the hospital, except those for which 
the waivers and flexibilities under this subsection apply.
``(3) The hospital shall provide to the Secretary, at a 
time, form and manner determined by the Secretary, any data and 
information the Secretary determines necessary to do the 
following:
``(A) Monitor the quality of care furnished, and to 
the extent practicable ensure the safety of, eligible 
beneficiaries and analyze costs of such care.
``(B) Undertake the study described in subsection 
(e).
``(4) The hospital meets such other requirements and 
conditions as the Secretary determines appropriate.
``(d) Termination.--The Secretary may terminate a hospital from 
participation in the Program (and the waivers and flexibilities 
applicable to such hospital) if the Secretary determines that the 
hospital no longer meets the criteria described in subsection (c).
``(e) Study and Report.--
``(1) In general.--The Secretary shall conduct a study to--
``(A) analyze, to the extent practicable, the 
criteria established by hospitals to determine which 
beneficiaries may be furnished services under the 
Program; and
``(B) analyze and compare, to the extent 
practicable--
``(i) the quality of care furnished to 
beneficiaries with similar conditions and 
characteristics in the hospital setting and 
through the Program, including health outcomes, 
hospital readmission rates, hospital mortality 
rates, length of stay, infection rates, and 
patient experience of care;
``(ii) clinical conditions treated and 
diagnosis-related groups of discharges from the 
hospital setting and under the Program;
``(iii) costs incurred by furnishing care 
in the hospital setting and through the 
Program;
``(iv) the quantity, mix and intensity of 
such services (such as in-person visits and 
virtual contacts with patients) furnished under 
the Program and furnished in the hospital 
setting; and
``(v) socioeconomic information on 
beneficiaries treated under the Program, 
including racial and ethnic data, income, and 
whether such beneficiaries are dually eligible 
for benefits under this title and title XIX.
``(2) Report.--Not later than 1 year after the completion 
of the Program, the Secretary shall post on a website of the 
Centers for Medicare & Medicaid Services a report on the study 
conducted under paragraph (1).
``(f) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement this section by program instruction or 
otherwise.
``(g) Publicly Available Information.--The Secretary shall, as 
feasible, make the information collected under subsections (c)(3) and 
(e)(1) available on the Medicare.gov Internet website (or a successor 
website).''.
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