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.
US Code:
42 USC 591, 592, Name of Law: Public Health Service Act
US Code: 42
USC 186 Name of Law: Social Security Act
The estimated burden decreased
with this collection. S&C memo: 14-27-Hospital-CAH/DPU, under
42 CFR §482.13(g), requires CAH’s 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.
$109,046
No
No
No
No
No
Uncollected
Denise King 410 786-1013
Denise.King@cms.hhs.gov
No
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