Can a paramedic make the in-person visits?

Yes, if the RN decides it fits the nursing plan. CMS says the paramedic should be recognized as Mobile Integrated Health or community paramedicine and be employed by or under contract with the hospital; if the RN decides an RN should see the patient, one of the two daily visits must be by an RN.

Do patients have to come through the emergency department?

Patients must enter from an emergency department or an inpatient hospital setting, according to CMS's FAQ.

Does a phone line meet the emergency connection rule?

CMS's FAQ says audio can meet it, as long as there is an immediate connection to the hospital-at-home team as described in the waiver request template.

Can a partner home health agency provide the therapy?

Yes. CMS says the therapy should not be delivered as part of a home health episode, should be supervised by the attending physician or APP, and should be documented in the hospital record.

Hospital-at-home logistics checklist

Updated October 8, 2026 · 2 min read

Under the CMS hospital-at-home waiver, each patient needs a daily physician or APP evaluation, a daily RN evaluation, at least two in-person visits and two sets of vital signs a day, an immediate audio line to the team, and emergency staff at home within 30 minutes. The hospital also provides or contracts for pharmacy, infusion, respiratory care, labs, imaging, transport, meals, equipment, therapy and social work.

Where the waiver stands

CMS's program page, checked on October 8, 2026, says the initiative was extended most recently by the Consolidated Appropriations Act, 2026. Unless Congress extends it again, patients at home must be discharged or returned to the hospital on September 30, 2030, and CMS stops accepting waiver requests after September 1, 2030. CMS's approved list, updated as of September 21, 2026, shows 363 approved hospitals across 135 health systems in 37 states.

Each hospital applies under its own CMS Certification Number, and every patient must enter from an emergency department or an inpatient unit.

Visits and response times

Minimums in the CMS waiver request template
Item	CMS minimum	What logistics must arrange
Physician or APP	In person at admission, then at least daily; daily visits can be remote when appropriate	A provider, and a video link if remote, for every patient every day
RN	At least once a day, in person or remote, with a nursing plan	An RN contact on every patient's day
In-person visits	At least 2 a day, by an RN or a Mobile Integrated Health paramedic, per the nursing plan	Two routed stops per patient per day
Vital signs	At least 2 sets a day, taken in person: heart rate, blood pressure, respiratory rate, oxygen saturation, temperature	One set at each of the two in-person visits
Remote contact	Immediate, on-demand audio connection to a team member who can connect an RN or physician	A staffed line at all hours
Emergency	Emergency personnel in the home within 30 minutes; 911 or emergency paramedics can provide it	A written response plan, with timing, for every address

Services to provide or contract

Pharmacy, meeting each patient's medicine needs.
Infusion, including IV push and IV piggyback.
Respiratory care, including oxygen delivery and nebulizer treatment.
Diagnostics: labs and radiology, with the expected time from order to result.
Transport between the emergency department and home, and back to the hospital if needed.
Meals, available as the patient needs them.
Durable medical equipment, such as a commode chair, walker, cane or hospital bed.
Physical, occupational and speech therapy, including whether it can be provided the same day.
Social work and care coordination, including discharge.

Worked example: one patient-day

Example day 2 for one patient admitted from the ED at 22:00 (fictional)
Time	Who	What
07:30	RN, in person	Vital signs set 1, IV dose, nursing plan
09:30	Physician, video	Daily evaluation
11:00	Pharmacy courier	Next IV doses delivered
18:30	Paramedic, in person	Vital signs set 2, check against the plan

That is two routed visits, one delivery and one video call for a single patient. At a census of 10, the minimums alone mean 20 in-person visits and 20 sets of vital signs a day, before any deliveries, therapy or discharges.

Capillary's routing, shown as a demo, plans home visits for clinicians, couriers and equipment around visit windows, skills and travel time. See Capillary for hospital-at-home programs and hospital-at-home staffing models.

Common questions

Can a paramedic make the in-person visits?: Yes, if the RN decides it fits the nursing plan. CMS says the paramedic should be recognized as Mobile Integrated Health or community paramedicine and be employed by or under contract with the hospital; if the RN decides an RN should see the patient, one of the two daily visits must be by an RN.
Do patients have to come through the emergency department?: Patients must enter from an emergency department or an inpatient hospital setting, according to CMS's FAQ.
Does a phone line meet the emergency connection rule?: CMS's FAQ says audio can meet it, as long as there is an immediate connection to the hospital-at-home team as described in the waiver request template.
Can a partner home health agency provide the therapy?: Yes. CMS says the therapy should not be delivered as part of a home health episode, should be supervised by the attending physician or APP, and should be documented in the hospital record.

Plan home visits around windows, skills and drive time.

Capillary's routing module plans the day for clinicians, couriers and equipment. See it with sample data.

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