HB8923, the At HOME Services Act of 2026, would direct the Secretary of Health and Human Services to create a 2-year Medicare demonstration program allowing participating hospitals to provide outpatient observation services to eligible Medicare beneficiaries in their homes. The program would be modeled on the Acute Hospital Care at Home initiative and would permit selected hospitals to use certain waivers and flexibilities, including relief from some in-facility nursing, physical environment, Life Safety Code, and telehealth-originating-site requirements, so long as the hospital meets specified criteria.
To participate, hospitals would have to maintain the same standard of care at home as in the inpatient setting, satisfy patient safety requirements, and submit data to CMS for oversight and evaluation. The bill also requires the Secretary to study and compare care quality, outcomes, utilization, costs, service intensity, and beneficiary demographics between home-based observation care and hospital-based care. A report would be posted on the CMS website within a year after the demonstration ends, and certain collected information would be made publicly available on Medicare.gov as feasible.
The bill would amend Title XVIII of the Social Security Act by adding a new Medicare demonstration authority for hospital-provided observation services at home. It would temporarily expand the circumstances under which hospitals can furnish observation-level care outside the hospital, while preserving federal oversight through safety standards, reporting, and the ability of the Secretary to terminate noncompliant hospitals. The measure would affect Medicare beneficiaries, participating hospitals, CMS, and potentially Medicare payment and care-delivery practices by testing whether home-based observation care can substitute for traditional hospital observation services.
Based on the bill text and available context, the measure appears generally favorable and innovation-oriented, with bipartisan sponsorship from Representatives Castor and Buchanan. The absence of recorded committee debate or votes suggests no documented opposition in the provided materials, and the bill’s structure reflects a cautious pilot approach rather than a permanent policy change. Its emphasis on quality, safety, and evaluation indicates an effort to balance expanded home-based care with oversight.
The main potential points of contention are patient safety, equivalency of care, and the scope of regulatory waivers. Critics could question whether home-based observation can truly match inpatient standards, especially for medically complex beneficiaries, and whether relaxing hospital staffing and facility requirements could create risks. There may also be concern about which patients are selected for the program, how outcomes are measured, and whether the demonstration could disproportionately serve or exclude certain populations; the bill addresses this by requiring demographic data collection, including race, ethnicity, income, and dual-eligibility status.