Crosswalk - AHCAH

Revisions to Form CMS-10752 Submissions of Acute Hospital Care at Home Waiver
Issue
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Section

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Section 1

Action to be
performed
Revised as follows:

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Section 1

Revise as follows:

3.

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Section 1

Revise as follows

4.

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Section 1

Revise as follows

Changes to the Application

Reason for the Change

Added question for respondent:
Describe the process to address advanced care
planning, including code status updates and possible
palliative care consultation prior to patient
admissions?:
Added question for respondent:
Describe the process for communicating with the
patient support person that the hospital is
responsible for providing all patient care needs,
including medication administration, transportation,
treatments, meals, and patient hygiene?:
Added question for respondent:
Describe the process for patient informed consent,
including communication of patient expectations for
care?:
Added question for respondent:
Describe the emergency response plan in the event
the patient does not respond to remote
communication or is unable to be reached for inperson visits?:

Question was added to meet the
regulatory requirements for all hospitals
for Patients Rights Conditions of
Participation at 42 CFR 482.13 that were
waived during the PHE.
Question was added to meet the
statutory requirements outlined in the
Consolidated Appropriations Act of
2023

Question was added to meet regulatory
requirements for all hospitals for Patient
Rights Conditions of Participation at 42
CFR 482.13
Question was added to address the
requirements for emergency response as
required by each hospital.

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