[Congressional Record Volume 171, Number 200 (Monday, December 1, 2025)]
[House]
[Pages H4935-H4937]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HOSPITAL INPATIENT SERVICES MODERNIZATION ACT
Mr. SMITH of Missouri. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 4313) to amend title XVIII of the Social Security
Act to extend acute hospital care at home waiver flexibilities, and to
require an additional study and report on such flexibilities, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 4313
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 ``Hospital Inpatient Services
Modernization Act''.
SEC. 2. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER
FLEXIBILITIES.
Section 1866G(a)(1) of the Social Security Act (42 U.S.C.
1395cc-7(a)(1)) is amended by striking ``January 30, 2026''
and inserting ``September 30, 2030''.
SEC. 3. REQUIRING ADDITIONAL STUDY AND REPORT ON ACUTE
HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES.
Section 1866G of the Social Security Act (42 U.S.C. 1395cc-
7), as amended by section 2, is further amended--
(1) in subsection (a)(3)(E)--
(A) in clause (ii), by striking ``the study described in
subsection (b)'' and inserting ``the studies described in
subsections (b) and (c)''; and
(B) by adding at the end the following new flush sentence:
``The Secretary may require that such data and information be
submitted through a hospital's cost report, through such
survey instruments as the Secretary may develop, through
medical record information, or through such other means as
the Secretary determines appropriate.'';
(2) in subsection (b)--
(A) in the subsection heading, by striking ``Study'' and
inserting ``Initial Study''; and
(B) in paragraph (3), by inserting ``or subsection (c)''
before the period at the end;
(3) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(4) by inserting after subsection (b) the following new
subsection:
``(c) Subsequent Study and Report.--
``(1) In general.--Not later than September 30, 2028, the
Secretary shall conduct a study to--
``(A) analyze, to the extent practicable, the criteria
established by hospitals under the Acute Hospital Care at
Home initiative to determine which individuals may be
furnished services under such initiative; and
``(B) analyze and compare (both within and between
hospitals participating in the initiative, and relative to
comparable hospitals that do not participate in the
initiative, for relevant parameters such as diagnosis-related
groups)--
``(i) quality of care furnished to individuals with similar
conditions and characteristics in the inpatient setting and
through the Acute Hospital Care at Home initiative, including
health outcomes, hospital readmission rates (including
readmissions both within and beyond 30 days post-discharge),
hospital mortality rates, length of stay, infection rates,
composition of care team (including the types of labor used,
such as contracted labor), the ratio of nursing staff,
transfers from the hospital to the home, transfers from the
home to the hospital (including the timing, frequency, and
causes of such transfers), transfers and discharges to post-
acute care settings (including the timing, frequency, and
causes of such transfers and discharges), and patient and
caregiver experience of care;
``(ii) clinical conditions treated and diagnosis-related
groups of discharges from inpatient settings relative to
discharges from the Acute Hospital Care at Home initiative;
``(iii) costs incurred by the hospital for furnishing care
in inpatient settings relative to costs incurred by the
hospital for furnishing care through the Acute Hospital Care
at Home initiative, including costs relating to staffing,
equipment, food, prescriptions, and other services, as
determined by the Secretary;
``(iv) the quantity, mix, and intensity of services (such
as in-person visits and virtual contacts with patients and
the intensity of such services) furnished in inpatient
settings relative to the Acute Hospital Care at Home
initiative, and, to the extent practicable, the nature and
extent of family or caregiver involvement;
``(v) socioeconomic information on individuals treated in
comparable inpatient settings relative to the initiative,
including racial and ethnic data, income, housing, geographic
proximity to the brick-and-mortar facility and whether such
individuals are dually eligible for benefits under this title
and title XIX; and
``(vi) the quality of care, outcomes, costs, quantity and
intensity of services, and other relevant metrics between
individuals who entered into the Acute Hospital Care at Home
initiative directly from an emergency department compared
with individuals who entered into the Acute Hospital Care at
Home initiative directly from an existing inpatient stay in a
hospital.
``(2) Selection bias.--In conducting the study under
paragraph (1), the Secretary shall, to the extent
practicable, analyze and compare individuals who participate
and do not participate in the initiative controlling for
selection bias or other factors that may impact the
reliability of data.
``(3) Report.--Not later than September 30, 2028, the
Secretary of Health and Human Services shall submit to the
Committee on Ways and Means of the House of Representatives
and the Committee on Finance of the Senate a report on the
study conducted under paragraph (1).
``(4) Funding.--In addition to amounts otherwise available,
there is appropriated to the Centers for Medicare & Medicaid
Services Program Management Account for fiscal year 2026, out
of any amounts in the Treasury not otherwise appropriated,
$2,500,000, to remain available until expended, for purposes
of carrying out this subsection.''.
SEC. 4. MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``$1,403,000,000'' and
inserting ``$1,400,500,000''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Missouri (Mr. Smith) and the gentlewoman from Wisconsin (Ms. Moore)
each will control 20 minutes.
The Chair recognizes the gentleman from Missouri.
General Leave
Mr. SMITH of Missouri. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and submit extraneous material on this bill under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Missouri?
There was no objection.
Mr. SMITH of Missouri. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise in support of the Hospital Inpatient Services
Modernization Act introduced by the Committee on Ways and Means Health
Subcommittee chairman, Mr. Buchanan, and Congressman Dwight Evans.
I think one of the healthcare-related conversations that frustrates a
lot of us around here is the typical year-end healthcare policy
extender mess.
{time} 1630
The legislation in front of us takes the successful hospital at home
program and removes it from that chaos by providing it with a renewed
5-year authorization so more Americans can receive care in the comfort
and convenience of their own home.
Hospital at home has become embedded in the fabric of our healthcare
system. More than 400 hospitals in nearly 40 States have participated
in the program, which has built a track record of improved patient
outcomes.
In Health Subcommittee Chairman Buchanan's home State of Florida
[[Page H4936]]
alone, there are 23 hospitals participating in this program. Hospital
care provided at home cuts mortality rates, reduces the risk of falls
and infections, and lowers recovery times. It also can save costs
versus expensive in-person hospital visits. It is no wonder that 99
percent of patients said they were satisfied with the program.
At a Ways and Means Committee hearing, we heard the incredible story
of a hospital at home patient from North Carolina named Roy who was
diagnosed with sepsis and initially treated in a hospital. There, he
was disturbed by beeping sounds, uncomfortable in the hospital gown,
and alone with no one able to visit him. His recovery was much better
at home.
He was able to sleep in his own bed and visit with friends and
family. He also continued to receive the same level of care he would
have otherwise received at the hospital. His recovery at home was
rapid, complete, and without any infections.
Mr. Speaker, I represent one of the most rural districts in America.
The long drives to a hospital faced by people living in small towns in
remote areas can make seeking care prohibitive. Hospital at home
shrinks the physical distance stopping rural patients from getting
care. Hospital at home has been a proven success for getting more
Americans the healthcare that they need.
Mr. Speaker, I reserve the balance of my time.
Ms. MOORE of Wisconsin. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I am really happy to see the chairman of the Ways and
Means Committee, and I am certainly happy to support this 5-year
extension of the hospital at home program, which, of course, includes a
critical study to ensure additional information about the program. I am
also happy to hear about the success of this program as people
experience it.
Mr. Speaker, the provisions, as the chairman of the Ways and Means
Committee has pointed out, get extended every single year. Sometimes
they get extended in short increments. Sometimes they move as a kind of
tax package. As a matter of fact, this was just extended in the
continuing resolution that we just passed and in previous funding bills
before that. I am so delighted to be here this evening to see that my
Republican colleagues are in the mood to extend current law.
I will offer them the opportunity to maybe extend the Affordable Care
Act to the 24 million Americans who are facing unprecedented enormous
health insurance premium hikes since we are extending healthcare stuff
today.
In my own State of Wisconsin, Mr. Speaker, 279,000 people receive
credits to help make insurance coverage affordable. In my State, for a
60-year-old couple not yet eligible for Medicare, earning $85,000 a
year, they will see their premiums increase by $23,281 a year. A family
of four earning $133,000 a year would see their premiums increase by
$14,000 next year.
Families are going to be asked to pay 20, 30, 40 percent of their
income for health insurance premiums, and the majority just wants to
ignore it. My constituents and your constituents, Mr. Speaker,
Americans from coast to coast are going to be staring down these
massive amounts of medical debt, massive insurance premiums, or the
inability to access healthcare. If they are unable to afford it, they
will just drop it.
We have to act. It is December 1. We have to act.
I am reminded, Mr. Speaker, of how fast the Ways and Means Committee
and the majority moved to give tax breaks to the wealthy, but when it
comes to regular families, we just don't seem to have the time. We
could be doing that here on the floor now. This is a marvelous bill we
are passing today, but I would much rather be securing the time for
that purpose.
Those hikes in healthcare premiums are not isolated, Mr. Speaker.
They come on the heels of the One Big Beautiful Bill Act that slashed
more than 10 million Americans out of healthcare through the Medicaid
program, cut over a trillion dollars in Medicare, and a half-trillion
dollar liability in the Medicare fund. Hospitals will close, patients
will suffer, and millions of American families will become uninsured
all because the majority is refusing to act.
Mr. Speaker, the majority was more than happy to make a whole host of
tax breaks permanent for the billionaire business class, but not for
these entrepreneurs and families who are facing these tremendous hikes
in their premiums. This is part of a Republican economy, I think. Help
the billionaires. It will all trickle down. We are going to heap the
costs onto middle-class families from every angle. Rising numbers of
Americans are falling behind on their utility bills. There is a recent
uptick in mortgage delinquencies and a rise in serious delinquency
rates for the first time in years. Consumer bankruptcies are on the
rise, up 15 percent since last year.
What are we doing? We just passed a $4.3 trillion tax break
overwhelmingly for the wealthy.
What else did the majority do, Mr. Speaker?
They found $40 billion for certain people in Argentina, but no
healthcare for American families. They found $300 million for a new
gilded ballroom where the East Wing of the White House used to be. The
ballroom keeps getting bigger and bigger, so I can't describe the
dimensions of it, but it is going to have a marble bathroom in it and a
fancy new patio, but no healthcare for families.
We have higher electric prices, grocery prices, and housing prices.
Half the people in my State who are renting are paying more than a
third of their income for housing.
These prices are going through the roof. American families, unless
they are billionaires, are struggling to stay afloat in this economy.
While President Trump and his family use the White House to haul in
billions of dollars to line their own pockets, people will not be able
to access healthcare.
Mr. Speaker, while I support this bill, I object to how the majority
and the President are making life worse every single day for most
Americans.
Mr. Speaker, I reserve the balance of my time.
{time} 1640
Mr. SMITH of Missouri. Mr. Speaker, I yield such time as he may
consume to the gentleman from Florida (Mr. Buchanan).
Mr. BUCHANAN. Mr. Speaker, I thank the chairman for his leadership on
this topic. It has been key to what we have accomplished today.
I rise today in strong support of my bill, the Hospital Inpatient
Services Modernization Act, which would allow hospitals to treat
Medicare patients safely at home.
During the pandemic, CMS established the hospital at home waiver to
provide hospitals with the flexibility to care for patients from the
comfort and convenience of their homes.
The hospital at home program has been very successful, being treated
in many homes across the country. It has also made a big difference in
reducing the risk of infections and falls.
I am thrilled to say that my bill extends the successful hospital at
home program for an additional 5 years. I know a lot of people being in
Florida where their parents will talk about the importance of if they
could stay at home, and I know this is critical.
An extension of this program would ensure more than 200 hospitals
across 34 States--including 20 hospitals in Florida--can continue to
provide quality care to patients at home. More than 140 leading
healthcare organizations, including hospitals, healthcare providers,
and patients support this legislation.
I thank Mr. Smucker, Mr. Evans, and Ms. Moore for their friendship
and bipartisanship on this bill. I thank Leader Scalise and Whip Emmer
for bringing this to the floor tonight. I urge my colleagues to support
the hospital at home program extension for hospitals, providers, and
patients.
Ms. MOORE of Wisconsin. Mr. Speaker, I yield myself the balance of my
time to close.
I congratulate Mr. Buchanan and Mr. Evans on bringing forth this
bill. I certainly agree with them that people do better at home in many
instances and ought to have this as an option.
I look forward to the study that is involved in this iteration of the
bill that will inform us about ways to improve the bill.
As we look at healthcare as a whole, it is one of those sort of
broken markets that we have. We have 60 percent
[[Page H4937]]
of folks who get healthcare through their employer or government or
labor unions. We have another group of people who are disabled who get
healthcare. We have another group of people who are elderly, thank God
they get Medicare, but then there is the rest of us out there.
In a broken system of healthcare, we have got to be concerned about
those people. We have talked a lot about children with cancer. What if
you are 27 and you have cancer, and you are not getting healthcare
through an employer? You don't have one of them good government jobs.
You are not elected to anything. What do you do?
While we are passing legislation, I hope that before we adjourn, we
will not ignore the thousand-pound elephant in the room, and that is
the Republican Party standing in the way of doing it.
Mr. Speaker, I yield back the balance of my time.
Mr. SMITH of Missouri. Mr. Speaker, I yield such time as he may
consume to the gentleman from Pennsylvania (Mr. Smucker).
Mr. SMUCKER. Mr. Speaker, I thank the chairman for moving this bill
through Ways and Means and for having us consider this bill this
evening, the Hospital Inpatient Services Modernization Act, which is
legislation led by my friend, Congressman Buchanan. I appreciate his
leadership on this, and I was pleased to be able to support the effort,
as well.
This bipartisan bill would enable hospitals to extend their
successful hospital at home programs for another 5 years. The hospital
at home model gives hospitals the flexibility to treat certain patients
in the comfort and convenience of their own homes rather than in the
hospital facility.
Over 31,000 patients received acute level care in their homes as of
October 2024, and studies show that hospital systems achieved savings
of 19 percent regarding these patients who required a shorter average
length of stay and used fewer unnecessary services.
A number of hospitals in my district have used the hospital at home
waiver to great effect. For example, one system with a hospital in my
community has accepted more than 800 patients across all of their
facilities, freeing up more than 1,500 hospital bed days and saving
approximately $1.1 million.
This is exactly the kind of program that we should be encouraging. It
allows medical providers to innovate and provide better care for their
patients. Patients like being at home, as well. It decreases costs over
the long run. By extending the hospital at home waiver for 5 years,
this bill that we are considering today would give hospitals the
certainty they need to continue to build out these innovative care
models and serve their patients in a holistic way after the disruption
caused by the Democratic shutdown.
Mr. Speaker, I encourage all of my colleagues to vote ``yes'' on this
important legislation, which is a clear win for patients and taxpayers.
Mr. SMITH of Missouri. Mr. Speaker, I urge my colleagues to approve
this legislation, and I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Missouri (Mr. Smith) that the House suspend the rules
and pass the bill, H.R. 4313, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________