[Federal Register Volume 72, Number 207 (Friday, October 26, 2007)]
[Rules and Regulations]
[Pages 60787-60789]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-21213]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 482
[CMS-3835-F2]
Medicare Program; Hospital Conditions of Participation:
Requirements for Approval and Re-Approval of Transplant Centers To
Perform Organ Transplants
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correcting amendment.
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SUMMARY: On March 30, 2007, we published a final rule entitled
``Medicare Program; Hospital Conditions of Participation: Requirements
for Approval and Re-Approval of Transplant Centers to Perform Organ
Transplants.'' The effective date was June 28, 2007. This correcting
amendment corrects a technical error identified in the March 30, 2007
final rule.
DATES: Effective Date: This correcting amendment is effective October
26, 2007.
FOR FURTHER INFORMATION CONTACT: Jeannie Miller, (410) 786-3164.
SUPPLEMENTARY INFORMATION:
I. Background
FR Doc. 07-1435 of March 30, 2007 (72 FR 15198) contained a
technical error that this rule serves to identify and correct. In
amending subpart E of part 482, we inadvertently omitted existing
Sec. Sec. 482.60, 482.61, 482.62, and 482.66. Our intention was to
retain these sections, which address psychiatric hospitals and ``swing-
bed'' hospitals, without change.
II. Summary of Errors in the Regulations Text
In amending subpart E of part 482, we inadvertently omitted
existing Sec. Sec. 482.60, 482.61, 482.62, and 482.66. Our intention
was to retain these sections, which address psychiatric hospitals and
``swing-bed'' hospitals, without change.
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a notice such as this take effect in accordance with
section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C.
553(b)). We also ordinarily provide a 30-day delay in the effective
date of the provisions of a rule in accordance with section 553(d) of
the APA (5 U.S.C. 553(d)). However, we can waive both the notice and
comment procedure and the 30-day delay in effective date if the
Secretary finds, for good cause, that a notice and comment process and
a 30-day delay in effective date are impracticable, unnecessary, or
contrary to the public interest, and incorporates a statement of the
finding and the reasons therefore in the notice.
We find for good cause that it is unnecessary to undertake notice
and comment rulemaking because this final rule merely provides
technical corrections to the regulations. We are not making any changes
to our existing regulations, but reinstating provisions that have
previously been approved and were unintentionally omitted from the
final rule that appeared in the March 30, 2007 Federal Register (72 FR
15198). Therefore, we believe that undertaking further notice and
comment procedures to incorporate these corrections into the update
notice is unnecessary and contrary to the public interest.
Further, we believe a delayed effective date is unnecessary because
this correcting amendment merely reinstates provisions already approved
and in effect. Therefore, we find good cause to waive notice and
comment procedures, as well as the 30-day delay in effective date.
List of Subjects in 42 CFR Part 482
Grant programs--health, Hospitals, Medicare, Reporting and
recordkeeping requirements.
0
Accordingly, 42 CFR chapter IV is corrected by making the following
correcting amendments to part 482.
[[Page 60788]]
PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS
0
1. The authority citation for part 482 continues to read as follows:
Authority: Secs. 1102, 1871 and 1881 of the Social Security Act
(42 U.S.C. 1302, 1395hh, and 1395rr), unless otherwise noted.
0
2. Subpart E--Requirements for Specialty Hospitals is amended by adding
Sec. Sec. 482.60, 482.61, 482.62, and 482.66, to read as follows:
* * * * *
Subpart E--Requirements for Specialty Hospitals
Sec.
482.60 Special provisions applying to psychiatric hospitals.
482.61 Condition of participation: Special medical record
requirements for psychiatric hospitals.
482.62 Condition of participation: Special staff requirements for
psychiatric hospitals.
482.66 Special requirements for hospital providers of long-term care
services (``swing-beds'').
* * * * *
Subpart E--Requirements for Specialty Hospitals
Sec. 482.60 Special provisions applying to psychiatric hospitals.
Psychiatric hospital must--
(a) Be primarily engaged in providing, by or under the supervision
of a doctor of medicine or osteopathy, psychiatric services for the
diagnosis and treatment of mentally ill persons;
(b) Meet the conditions of participation specified in Sec. Sec.
482.1 through 482.23 and Sec. Sec. 482.25 through 482.57;
(c) Maintain clinical records on all patients, including records
sufficient to permit CMS to determine the degree and intensity of
treatment furnished to Medicare beneficiaries, as specified in Sec.
482.61; and
(d) Meet the staffing requirements specified in Sec. 482.62.
Sec. 482.61 Condition of participation: Special medical record
requirements for psychiatric hospitals.
The medical records maintained by a psychiatric hospital must
permit determination of the degree and intensity of the treatment
provided to individuals who are furnished services in the institution.
(a) Standard: Development of assessment/diagnostic data. Medical
records must stress the psychiatric components of the record, including
history of findings and treatment provided for the psychiatric
condition for which the patient is hospitalized.
(1) The identification data must include the patient's legal
status.
(2) A provisional or admitting diagnosis must be made on every
patient at the time of admission, and must include the diagnoses of
intercurrent diseases as well as the psychiatric diagnoses.
(3) The reasons for admission must be clearly documented as stated
by the patient and/or others significantly involved.
(4) The social service records, including reports of interviews
with patients, family members, and others, must provide an assessment
of home plans and family attitudes, and community resource contacts as
well as a social history.
(5) When indicated, a complete neurological examination must be
recorded at the time of the admission physical examination.
(b) Standard: Psychiatric evaluation. Each patient must receive a
psychiatric evaluation that must--
(1) Be completed within 60 hours of admission;
(2) Include a medical history;
(3) Contain a record of mental status;
(4) Note the onset of illness and the circumstances leading to
admission;
(5) Describe attitudes and behavior;
(6) Estimate intellectual functioning, memory functioning, and
orientation; and
(7) Include an inventory of the patient's assets in descriptive,
not interpretative, fashion.
(c) Standard: Treatment plan. (1) Each patient must have an
individual comprehensive treatment plan that must be based on an
inventory of the patient's strengths and disabilities.
The written plan must include--
(i) A substantiated diagnosis;
(ii) Short-term and long-range goals;
(iii) The specific treatment modalities utilized;
(iv) The responsibilities of each member of the treatment team; and
(v) Adequate documentation to justify the diagnosis and the
treatment and rehabilitation activities carried out.
(2) The treatment received by the patient must be documented in
such a way to assure that all active therapeutic efforts are included.
(d) Standard: Recording progress. Progress notes must be recorded
by the doctor of medicine or osteopathy responsible for the care of the
patient as specified in Sec. 482.12(c), nurse, social worker and, when
appropriate, others significantly involved in active treatment
modalities. The frequency of progress notes is determined by the
condition of the patient but must be recorded at least weekly for the
first 2 months and at least once a month thereafter and must contain
recommendations for revisions in the treatment plan as indicated as
well as precise assessment of the patient's progress in accordance with
the original or revised treatment plan.
(e) Standard: Discharge planning and discharge summary. The record
of each patient who has been discharged must have a discharge summary
that includes a recapitulation of the patient's hospitalization and
recommendations from appropriate services concerning follow-up or
aftercare as well as a brief summary of the patient's condition on
discharge.
Sec. 482.62 Condition of participation: Special staff requirements
for psychiatric hospitals.
The hospital must have adequate numbers of qualified professional
and supportive staff to evaluate patients, formulate written,
individualized comprehensive treatment plans, provide active treatment
measures, and engage in discharge planning.
(a) Standard: Personnel. The hospital must employ or undertake to
provide adequate numbers of qualified professional, technical, and
consultative personnel to:
(1) Evaluate patients;
(2) Formulate written individualized, comprehensive treatment
plans;
(3) Provide active treatment measures; and
(4) Engage in discharge planning.
(b) Standard: Director of inpatient psychiatric services; medical
staff. Inpatient psychiatric services must be under the supervision of
a clinical director, service chief, or equivalent who is qualified to
provide the leadership required for an intensive treatment program. The
number and qualifications of doctors of medicine and osteopathy must be
adequate to provide essential psychiatric services.
(1) The clinical director, service chief, or equivalent must meet
the training and experience requirements for examination by the
American Board of Psychiatry and Neurology or the American Osteopathic
Board of Neurology and Psychiatry.
(2) The director must monitor and evaluate the quality and
appropriateness of services and treatment provided by the medical
staff.
(c) Standard: Availability of medical personnel. Doctors of
medicine or osteopathy and other appropriate professional personnel
must be available to provide necessary medical and surgical diagnostic
and treatment services. If medical and surgical diagnostic and
treatment services are
[[Page 60789]]
not available within the institution, the institution must have an
agreement with an outside source of these services to ensure that they
are immediately available or a satisfactory agreement must be
established for transferring patients to a general hospital that
participates in the Medicare program.
(d) Standard: Nursing services. The hospital must have a qualified
director of psychiatric nursing services. In addition to the director
of nursing, there must be adequate numbers of registered nurses,
licensed practical nurses, and mental health workers to provide nursing
care necessary under each patient's active treatment program and to
maintain progress notes on each patient.
(1) The director of psychiatric nursing services must be a
registered nurse who has a master's degree in psychiatric or mental
health nursing, or its equivalent from a school of nursing accredited
by the National League for Nursing, or be qualified by education and
experience in the care of the mentally ill. The director must
demonstrate competence to participate in interdisciplinary formulation
of individual treatment plans; to give skilled nursing care and
therapy; and to direct, monitor, and evaluate the nursing care
furnished.
(2) The staffing pattern must insure the availability of a
registered professional nurse 24 hours each day. There must be adequate
numbers of registered nurses, licensed practical nurses, and mental
health workers to provide the nursing care necessary under each
patient's active treatment program.
(e) Standard: Psychological services. The hospital must provide or
have available psychological services to meet the needs of the
patients.
(f) Standard: Social services. There must be a director of social
services who monitors and evaluates the quality and appropriateness of
social services furnished. The services must be furnished in accordance
with accepted standards of practice and established policies and
procedures.
(1) The director of the social work department or service must have
a master's degree from an accredited school of social work or must be
qualified by education and experience in the social services needs of
the mentally ill. If the director does not hold a masters degree in
social work, at least one staff member must have this qualification.
(2) Social service staff responsibilities must include, but are not
limited to, participating in discharge planning, arranging for follow-
up care, and developing mechanisms for exchange of appropriate,
information with sources outside the hospital.
(g) Standard: Therapeutic activities. The hospital must provide a
therapeutic activities program.
(1) The program must be appropriate to the needs and interests of
patients and be directed toward restoring and maintaining optimal
levels of physical and psychosocial functioning.
(2) The number of qualified therapists, support personnel, and
consultants must be adequate to provide comprehensive therapeutic
activities consistent with each patient's active treatment program.
Sec. 482.66 Special requirements for hospital providers of long-term
care services (``swing-beds'').
A hospital that has a Medicare provider agreement must meet the
following requirements in order to be granted an approval from CMS to
provide post-hospital extended care services, as specified in Sec.
409.30 of this chapter, and be reimbursed as a swing-bed hospital, as
specified in Sec. 413.114 of this chapter:
(a) Eligibility. A hospital must meet the following eligibility
requirements:
(1) The facility has fewer than 100 hospital beds, excluding beds
for newborns and beds in intensive care type inpatient units (for
eligibility of hospitals with distinct parts electing the optional
reimbursement method, see Sec. 413.24(d)(5) of this chapter).
(2) The hospital is located in a rural area. This includes all
areas not delineated as ``urbanized'' areas by the Census Bureau, based
on the most recent census.
(3) The hospital does not have in effect a 24-hour nursing waiver
granted under Sec. 488.54(c) of this chapter.
(4) The hospital has not had a swing-bed approval terminated within
the two years previous to application.
(b) Skilled nursing facility services. The facility is
substantially in compliance with the following skilled nursing facility
requirements contained in subpart B of part 483 of this chapter.
(1) Resident rights (Sec. 483.10 (b)(3), (b)(4), (b)(5), (b)(6),
(d), (e), (h), (i), (j)(1)(vii), (j)(1)(viii), (l), and (m)).
(2) Admission, transfer, and discharge rights (Sec. 483.12 (a)(1),
(a)(2), (a)(3), (a)(4), (a)(5), (a)(6), and (a)(7)).
(3) Resident behavior and facility practices (Sec. 483.13).
(4) Patient activities (Sec. 483.15(f)).
(5) Social services (Sec. 483.15(g)).
(6) Discharge planning (Sec. 483.20(e)).
(7) Specialized rehabilitative services (Sec. 483.45).
(8) Dental services (Sec. 483.55).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: October 22, 2007.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. E7-21213 Filed 10-25-07; 8:45 am]
BILLING CODE 4120-01-P