How the Hospital-at-Home Waiver Deadline Impacts Remote Patient Monitoring

How Hospital-at-Home Programs Advanced Remote Monitoring

When hospitals faced overwhelming demand during the pandemic, CMS introduced the Acute Hospital Care at Home (AHCAH) waiver. The initiative allows hospitals to deliver acute care  within a patient’s home while still receiving Medicare reimbursement. Since then, more than 400 hospitals across the country have been approved to participate, making Hospital-at-Home (HaH) one of the most significant care delivery shifts in recent years.

As part of these at-home programs, hospitals deployed remote patient monitoring (RPM) to manage conditions that once required round-the-clock bedside observation, and clinicians gained firsthand experience trusting data collected outside the hospital.

The waiver, already extended three times, is set to expire at the end of September 2025. Legislation has been introduced to prolong the initiative, and major healthcare groups have voiced their support. Still, the future of the waiver remains uncertain. Without it, the momentum behind RPM could slow not only in everyday care, but in clinical research.

In this blog, we will cover:

• How HaH programs accelerated the use of remote patient monitoring
• What the waiver’s expiration could mean for hospitals, clinicians, and patients
• Why long-term policy stability is necessary for sustaining HaH success

Evidence from HaH Programs

The waiver enabled hospitals to monitor high-acuity patients at home with RPM, capturing continuous streams of vital signs and ECG rhythms that once required inpatient observation. In doing so, HaH also functioned as a large-scale pilot for RPM itself, giving providers experience with the technology and producing evidence that continues to guide regulators and sponsors.

At the same time, clinical research increasingly embraced decentralized and hybrid trial models. Together, these two shifts accelerated the use of medical-grade wearables and other remote monitoring technologies. Each patient treated at home and each trial participant monitored remotely added to the growing evidence that these devices can supplement traditional observation.

Mass General Brigham, one of the largest systems to participate, studied more than 5,800 patients treated under the waiver. Fewer than 1% died while receiving care at home, which is a rate noticeably lower than the national inpatient average. Just 7% required transfer back to the hospital for extended stays.

CMS’s own review shared similar results. The agency’s recent report shows that allowing patients to be treated in the comfort of their homes can speed recovery, lower mortality rates, and reduce risks such as hospital-acquired infections and falls.

The Risk of HaH Waiver Expiration

These outcomes have steadily built trust in medical-grade wearables and remote workflows. Without the waiver, that progress could stall, and the field could lose an important proving ground at the very moment research and policy are beginning to rely on it.

Lawmakers have signaled before that HaH deserves more than year-to-year renewals. In 2024, lawmakers introduced a bill proposing a five-year extension of the waiver, which was widely backed by hospital and home-based care advocacy groups. Although the proposal did not move forward at the time, it laid the groundwork for this year’s proposed Hospital Inpatient Services Modernization Act, which would stretch the waiver through 2030.

While several large health systems have launched successful HaH programs, hospitals without the same scale or resources are less likely to invest without long-term regulatory guidance. Hospitals need clear policy to expand programs, clinicians need assurance to continue adopting remote workflows, and researchers need confidence that the infrastructure supporting RPM will be sustained.

Building on Proven Wearable Technology

While the waiver’s future is uncertain, the strong outcomes of HaH programs depend on many moving parts, but technology remains the core element that allows them to succeed. Medical-grade monitoring has allowed clinicians to track patient health in real time, reducing risks tied to longer hospital stays and showing that acute care at home can match — and for some conditions, even exceed — the safety of traditional inpatient care.

Health systems can build on this momentum by adopting technology that supports both patient care and research. Vivalink recently joined the Digital Medicine Society (DiMe), Consumer Technology Association, and UMass Chan Medical School’s Program in Digital Medicine, along with leading health systems and payors, to create a national HaH blueprint. The initiative gives hospitals a framework to sustain and expand at-home care, even as the Medicare waiver faces potential expiration.