2. Thank you for inviting me! Charles Moore Director Medical Facilities Bureau of Child Care & Health Facilities

3. Agenda  Physician Response Time  Construction Requirements  Disaster Preparedness Plans  Budget Issues-Mission & Priority Document

4. Why Disaster Preparedness and Plans are important.

5. KAR 28-34-3a General Requirements - specifies what measures the facility needs to take with regard to internal and external disaster plans.

6. CAH’s are also surveyed in accordance with federal regulations

7. C-0227 §485.623(c) Standard: Emergency Procedures The CAH assures the safety of patients in non- medical emergencies by-- (1) Training staff in handling emergencies, including prompt reporting of fires, extinguishing of fires, protection and, where necessary, evacuation of patients, personnel, and guests, and cooperation with fire fighting and disaster authorities;

8. Here is a sample of what CMS has directed our survey to look for…….   How does the CAH ensure that all personnel on its staff, including new additions to the staff, are trained to manage non-medical emergencies? Ask facility staff what they are supposed to do in case of an emergency such as a tornado or a blizzard. Review staff training documents and inservice records to validate training.

9.  Review the CAH’S written fire control plans to verify they contain the required provisions of the Life Safety Code or State law. Verify that CAH staff reported all fires as required to State officials. Interview staff throughout the facility to verify their knowledge of their responsibilities during a fire (this is usually done during the LSC survey, but health surveyors may also verify staff knowledge).

10. Physician response time……

11. Physician Response Time in CAH’s 42 CFR 485.618(d)  There must be a doctor of medicine or osteopothy, a physician assistant, or a practitioner with training or experience in emergency care on call and immediately available by telephone or radio contact, and available on site within the following time frames:

12. (A) Within 30 minutes, on a 24 hour a day basis, if the CAH is located in an area other than an area described as a frontier area: or

13. (B) Within 60 minutes, on a 24 hour basis, if the CAH is located in what the state has determined is a frontier county. Those counties that have been defined as frontier (meaning fewer than 6 residents per square mile - see following map and information)

16. Construction………

17. Remodeling, Renovation and New Construction  Please remember to have your architect contact me. All hospital construction, including new buildings and additions or alterations to existing buildings, shall be in accordance with the standards set forth in the American institute of architects academy of architecture for health, publication No. ISBN 1-55835-151-5, entitled “ 1996-97 Guidelines for Design and Construction of Hospitals and Health Care Facilities,” copyrighted in 1996, and hereby adopted by reference in KAR 28-34-32b.

18. What about the new guidelines? Architects can always ask for an exception to have portions or all of the new construction or renovation meet the 2001, 2006 or the upcoming 2010 Guidelines. Much like the entire health care filed, there will always be change.

19. Before commencing construction, the architect shall certify, in writing, to the Kansas Department of Health and Environment (KDHE) that the contract documents are in compliance with subsections (a), (b), and (c) of KAR 28- 34-32b.

20. Federal Budget Issues Funds are still not sufficient in FY 2009 budget to conduct initial surveys without CMS approval.

21. What this means to the providers in Kansas is that for initial certification surveys… …the burden is on the applicant to provide data and other evidence that effectively establish the probability of serious, adverse beneficiary health care access consequences if the provider is not enrolled to participate in Medicare.

22. 32 Initial Survey requests since Oct 1, 2007

23. Employment and Staffing ??

24. While we have 11 full time equivalents approved for our budget we currently have 9 FTE’s with no possibility at this time of hiring more health facility surveyors or replacing any that might leave.

25. 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:785-291-3419 cmoore@kdhe.state.ks.us

26. 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

27. 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)

28. QUESTIONS?