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HCFA Publishes Interim Final Rule on Use Restraint & Seclusion for Individuals Under 21 in Psychiatric Residential Treatment Facilities

The Health Care Financing Administration (HCFA) published an interim final rule with comment period in the January 22^nd Federal Register establishing standards for the use of restraint and seclusion that psychiatric residential treatment facilities must have in place in order to protect the health and safety of residents—especially those individuals under 21 years of age. The regulations are effective March 23, 2001. Comments are due on this interim final rule by 5 PM on March 23, 2001. See Regulations below.

This interim final rule implements provisions regarding the use of restraint and seclusion in the 1994 proposed rule for standards in non-hospital psychiatric treatment facilities, the July 1999 interim final rule for hospitals, and provisions in the Children’s Health Act of 2000, which President Clinton signed into law on October 17, 2000. These regulations establish a definition of psychiatric residential treatment facility as a facility other than a hospital that provides inpatient psychiatric services and sets forth a condition of participation (CoP) for the use of restraint or seclusion in psychiatric residential treatment facilities for individuals under age 21. The CoP provides for the use of restraint and seclusion on in emergency safety situation to ensure the safety of residents and others. The rule prohibits the use of restraint and seclusion simultaneously, requires that any order for restraint or seclusion must be the least restrictive intervention that is most likely to be effective, and provides time limits for the use of restraint/seclusion for individuals under 21. This interim rule also requires a face-to- of the initiation of the intervention. Facilities will now be required to inform residents (and parents/guardians in the case of a minor) of its policy regarding the use of restraint/seclusion. Reports of any injury or death of a resident must be made by the facility to the state Medicaid agency, indicating if restraint/seclusion was used immediately prior to the death or injury. Facilities will have 120 days from the effective date of the rule (March 23^rd) to provide the state Medicaid agency with an attestation of compliance with this interim final rule. A copy of HCFA’s interim final rule on restraint and seclusion is available from the January 22^nd Federal Register at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2001_register&docid=01-1649-filed.

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