2. Topics covered today:  Observation Beds  Initial Surveys  Deaths Related to Restraint/Seclusion  Other

3. Observation Services in CAH’s April 4, 2008 (S&C 08-16)  A CAH may maintain beds used solely for outpatient services without counting these beds toward the statutory CAH maximum of 25 inpatient beds.

4.  KDHE must examine CAH provision of outpatient observation services carefully to assure they are consistent with statutory limit of 25 inpatient beds that have annual length of stay that does not exceed 96 hours per patient.  An revision to Appendix “W” has been made to address the assessment and observation of beds.

5. ???? INITIAL SURVEYS ???

6. While funding granted to KDHE is not sufficient to complete initial certification surveys of facilities requesting participation in the Medicare and/or Medicaid program in accordance with national priorities, we have been able to request those with an access issues be surveyed.

7. Thus far we have received approval to survey: 2 RHC 4 ESRD 1 Hospice (This is out of 19 requests)

8. S&C 08-23 Relates to deaths in hospitals associated with the use of restraints or seclusion. It has been revised to correspond to regulatory requirements at 42 CFR 482.13(g) and to reflect operational procedures implemented since the revised regulation took effect in January, 2007.

9. Hospitals must report the following information to CMS:  Each death that occurs while a patient is in restraint or seclusion.  Each death that occurs within 24 hours after the patient has been removed from restraint or seclusion.  Each death known to the hospital that occurs within one week after restraint or seclusion where it is reasonable to assume that use of restraint or placement in seclusion contributed directly or indirectly to a patient’s death. “Reasonable to assume” in this context includes, but is not limited to, deaths related to restrictions of movement for prolonged periods of time, or death related to chest compression, restriction of breathing, or asphyxiation.

10. 2. Each death must be reported to CMS by telephone (816-426-2011) no later than the close of business the next CMS business day following knowledge of the patient’s death. 3. Hospital staff must document in the patient’s medical record the date and time the death was reported to CMS.

11. Web site for Critical Access Hospital (CAH) Federal Regulations and Guidelines Appendix W http://www.kdheks.gov/bcchf/index.html Click on Bureau of Health Facilities and then forms to get to the above. http://www.kdheks.gov/bcchf/index.html

12. Who to call: Charles Moore, Director Medical Services Bureau of Child Care & Health Facilities 1000 SW Jackson, Suite 200 Topeka, KS 66612 e-mail: cmoore@kdhe.state.ks.us Charles Direct Line 785-296-0131 FAX:785-291-3419cmoore@kdhe.state.ks.us

13. Other contacts in our Bureau: Anita Hodge RN, State Survey Manager 296-0127 Lynn Searles, Risk Management Specialist291-3552 Tamara Wilkerson, Licensure & Certification 296-1263 Coordinator Lois Wilkins, Sr. Admin Assist-Licensure296-1258 Theresa Carter, Sr. Admin Assist-Certification296-1249 (all are Area code 785)