Hospital Inpatient Services Modernization Act
Sponsor
Vern Buchanan
Republican · FL-16
Latest Action · Dec 2, 2025
Received in the Senate and Read twice and referred to the Committee on Finance.
Bill Progress
Congress bets big on ‘hospital at home’
Why it matters
HR4313 would lock in five more years of Medicare’s hospital-at-home experiment, nudging the U.S. toward a fundamentally different model of acute care delivery.
The House quietly cast a big vote on the future of hospital care by passing HR4313, a five‑year extension of Medicare’s hospital‑at‑home waiver. The bill, rebranded as the Hospital Inpatient Services Modernization Act, would keep the pandemic‑era program alive through 2030 and order another federal study of how it’s working.
The big picture: Hospital‑at‑home flips the script on acute care, paying health systems to monitor and treat patients at home with round‑the‑clock virtual oversight and in‑person nursing visits instead of a traditional inpatient stay. More than 300 hospitals have used the flexibility since the initial waiver, and House backers are calling the model a "successful" innovation that needs stability to grow. Industry coalitions and telehealth advocates have cheered the bill as a way to lock in a highly popular option for patients while giving hospitals a pressure valve for overcrowded wards.
Yet the five‑year extension goes well beyond a short bridge. It would effectively cement hospital‑at‑home as a mainstream Medicare benefit before there’s definitive, system‑wide evidence on whether it reduces total spending, improves outcomes at scale, and avoids widening disparities between seniors who can safely be cared for at home and those who can’t.
Visual Summary
HR4313 at a Glance
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</div>What This Bill Does
Extends the hospital-at-home program for Medicare patients
The bill pushes the end date of an existing Medicare ‘acute hospital care at home’ program from 2025 to 2030. In simple terms, hospitals can keep treating some patients in their own homes instead of inside the hospital and still get paid by Medicare for five more years.
Requires more detailed data from hospitals running hospital-at-home
Hospitals that use the hospital-at-home program must keep sending data to the federal government, and the Secretary of Health and Human Services can decide how they submit it. That might be through financial forms hospitals already file, special surveys, medical records, or any other method the Secretary thinks works best.
Turns the existing study into an ‘initial’ study and adds a second one
The bill renames the current required review of hospital-at-home as the “initial study.” It then sets up a second, follow‑up study so the government isn’t just looking once, but checking again later how this program is working.
Orders a new federal study of who gets hospital-at-home care and how it compares to regular hospital care
By September 30, 2028, the Secretary has to study how hospitals decide which patients can safely get hospital-level care at home. The study must also compare things like quality of care for similar patients treated in the traditional hospital versus at home, both across different hospitals using the program and against similar hospitals that don’t use it.
Who Benefits
Medicare patients who qualify for hospital-at-home care
They get five more years where they might be able to receive full hospital-level treatment while staying in their own homes instead of in a hospital bed. This can mean more comfort, fewer hospital stays, and still having Medicare cover the care.
Hospitals currently using or planning to use hospital-at-home programs
They gain long-term certainty that Medicare will keep paying for hospital-at-home through 2030. That makes it easier to invest in staff, technology, and processes needed to run care-at-home safely, instead of worrying the program will suddenly end in 2025.
Federal health officials and policymakers
They get more and better data from hospitals and two rounds of studies to see how well hospital-at-home works. That helps them decide later whether to keep, change, or expand these flexibilities based on real-world results, not guesswork.
Researchers studying hospital quality and safety
The required data and the new study create a structured way to compare home-based hospital care to traditional hospital stays. That provides a richer evidence base for understanding what kinds of patients do better or worse in each setting.
Who's Affected
Hospitals participating in Medicare’s acute hospital care at home initiative
They must keep following the program’s rules for up to five more years and also respond to new data requests in whatever format the Secretary chooses (cost reports, surveys, medical records, etc.). Day to day, that means more ongoing reporting and being ready for their patient selection criteria and outcomes to be analyzed and compared to other hospitals.
Comparable hospitals that do not use hospital-at-home
Even if they don’t run hospital-at-home programs, they may still be pulled into the comparison part of the federal study. Their patient outcomes and quality measures can be used as a baseline, which may require sharing data and could indirectly pressure them to consider similar programs if the results look good.
Medicare program administrators at the federal level
They have to manage the extended waiver through 2030, design and run new data collection methods, and complete the follow‑up study by the 2028 deadline. This adds to their workload in tracking how hospital-at-home is being used and whether it’s delivering safe, high‑quality care.
Health and Human Services Secretary and staff
They are directly tasked with deciding how hospitals must submit information and with carrying out the new study. Their practical job expands to include designing surveys or reporting systems and doing complex comparisons between different hospitals and treatment settings.
Cosponsors (8)
Recent Actions
Received in the Senate and Read twice and referred to the Committee on Finance.
Motion to reconsider laid on the table Agreed to without objection.
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4935)
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4935)
DEBATE - The House proceeded with forty minutes of debate on H.R. 4313.
Considered under suspension of the rules. (consideration: CR H4935-4937)
Mr. Smith (MO) moved to suspend the rules and pass the bill, as amended.
Placed on the Union Calendar, Calendar No. 311.
What Changes in the Law
5 key amendments · 5 total changes
Social Security Act, Section 1866G(a)(1) (42 U.S.C. 1395cc–7(a)(1))
20252030What this means: Extends the authority for Medicare’s Acute Hospital Care at Home waiver flexibilities by five years, from 2025 through 2030.
Social Security Act, Section 1866G(a)(3)(E)(ii) (42 U.S.C. 1395cc–7(a)(3)(E)(ii))
the study described in subsection (b)the studies described in subsections (b) and (c)What this means: Updates the data‑submission requirement so that hospitals must provide information for both the original study and a new follow‑up study on the hospital‑at‑home program.
Social Security Act, Section 1866G(a)(3)(E) (42 U.S.C. 1395cc–7(a)(3)(E))
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.What this means: Explicitly authorizes the Secretary of Health and Human Services to dictate the formats and channels (cost reports, surveys, medical records, etc.) hospitals must use to submit data about the hospital‑at‑home initiative.
Social Security Act, Section 1866G(b) heading (42 U.S.C. 1395cc–7(b))
STUDYINITIAL STUDYWhat this means: Redesignates the existing mandated study of the Acute Hospital Care at Home initiative as the “initial” study, setting up a series that includes a subsequent study.
Social Security Act, Section 1866G, new subsection (c) (42 U.S.C. 1395cc–7(c))
“(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 …”What this means: Creates a new required follow‑up study and report, due by September 30, 2028, to evaluate hospital‑at‑home patient selection criteria and compare quality of care between hospital‑at‑home and traditional inpatient settings, including against non‑participating hospitals.
Committees (2)
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Get a DemoWho's Lobbying
5 organizations lobbying on this bill
| Organization | Period |
|---|---|
COMPASSION & CHOICES via THE RABEN GROUP | Q3 |
CHRISTIANACARE | Q3 |
AMERICAN HOSPITAL ASSOCIATION | Q3 |
AMERICAN MEDICAL ASSOCIATION | Q3 |
AMERICA'S HEALTH INSURANCE PLANS INC (AHIP) via AMERICA'S HEALTH INSURANCE PLANS, INC. (AHIP) | Q3 |
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Full Bill Text
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