The Hospital Restraint/Seclusion Death Report Worksheet historically has been used by RO's internally as a data collection tool for hospitals reporting restraint/seclusion deaths as required by 482.13. In response to the Executive Order 13563 by reducing unnecessarily burdensome rules and thereby increasing the ability of hospitals and CAHs to devote resources to providing high quality patient care. The Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of Participation CMS-3244-F final rule responds. Within this rule is the change to 482.13 reducing the burden of reporting 2-point soft wrist restraint deaths. Additionally, it increases the methods for which hospitals may report all other restraint/seclusion related deaths, to include telephone, facsimile, and electronic. The Hospital Restraint/Seclusion Death Report Worksheet will now be used by all hospitals for required reporting by facsimile and electronic. Sections 1861(e)(1) through (8) of the Social Security Act (the Act) provide that a hospital participating in the Medicare program must meet certain specified requirements. Section 1861(e)(9) of the Act specifies that a hospital also must meet such other requirements as the Secretary finds necessary in the interest of the health and safety of individuals furnished services in the institution. Under this authority, the Secretary has established regulatory requirements that a hospital must meet to participate in Medicare at 42 CFR Part 482, CoPs for Hospitals. Section 1905(a) of the Act provides that Medicaid payments from States may be applied to hospital services. Under regulations at 42 CFR 440.10(a)(3)(iii), 42 CFR 440.20(a)(3)(ii), and 42 CFR 440.140, hospitals are required to meet the Medicare CoPs in order to participate in Medicaid.
The estimated burden decreased with this collection. S&C memo: 14-27-Hospital-CAH/DPU, under 42 CFR §482.13(g), requires CAHâs with DPUs to submit the hospital reporting of deaths associated with use of restraint or seclusion; since CAH DPUs are subject to the Hospital Conditions of Participation. This memo also excludes reporting of deaths in which only 2-point soft wrist restraints were used and the patient was not in seclusion at the time of death.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-10455 Hospital Restraint/Seclusion Death Report Worksheet
CMS-10455 Supporting Statement A passback 2.10.17.docx
Hospital Restraint/Seclusion Death Report Worksheet