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As of January 1, CMS eliminated the paper version of the form to report patient deaths associated with restraint or seclusion. Form CMS-10455 must be filed through an electronic version.

CMS announced the new electronic form and provided instructions on how to use it, including a video, in an Quality, Safety & Oversight Group memo, on December 2, 2019. Memo #QSO-20-04-Hospital-CAH DPU, “Electronic Form CMS-10455, Report of a Hospital Death Associated with Restraint or Seclusion,” can be found online here: https://www.cms.gov/electronic-form-cms-10455-report-hospital-death-associated-restraint-or-seclusion-0

In a newsletter to clients, Patton Healthcare Consulting noted that the requirements on which deaths to report remain the same. Only the method of reporting has changed.

“The QSO memo also details the specific fields of information which must be submitted, but this becomes somewhat easy in that you are filling in the blanks on the form,” says Patton Healthcare. “CMS also describes what the regional office will do with the information submitted including evaluating it for a potential survey and sharing of information with the accrediting bodies. Since this new process is effective immediately you will want to review the QSO memo and slide deck and make sure that the individual responsible at your hospital for reporting such deaths has the information.”

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