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The Health Care Financing Administration (HCFA) is issuing an interim final rule that establishes new standards for the use of restraints and seclusion that must be met by psychiatric residential treatment facilities that provide Medicaid's inpatient psychiatric benefit for individuals under age 21. These requirements give essential guidance to these psychiatric residential treatment facilities, which are rapidly replacing hospitals as a less restrictive treatment alternative for children and adolescents with psychiatric disorders. The rule further strengthens the protections by adding a new requirement that these facilities inform HCFA of any deaths involving restraints and seclusion.

These new protections take effect Tuesday, May 22.

In addition, HHS is developing a rule that will set similar standards on the use of restraints and seclusion on children in certain non-medical, community-based facilities for children and youth as required by the Children's Health Act that was enacted by Congress in 2000. HCFA already requires hospitals, nursing homes and intermediate care facilities for the mentally retarded that participate in Medicare or Medicaid to meet strong safety standards when using restraints or seclusion.

"This action will help protect vulnerable young people in certain Medicaid facilities from the risks of serious injury and death that are caused by the inappropriate use of restraints," Secretary Thompson said. "By developing a broader regulation covering other kinds of facilities, we will reach more children who need this type of protection."

The interim final rule amends a Jan. 18 regulation, clarifying which facilities must comply with these requirements and what constitutes a restraint. The amended rule uses language to define a restraint that is consistent with the Children's Health Act.

The amended rule also requires any use of seclusion or restraint in a covered Medicaid psychiatric facility to be performed only on the order and under the supervision of a physician, a registered nurse or other licensed practitioner permitted by the state to issue such orders, and who has been trained in the use of emergency safety interventions. These requirements, which are consistent with the Children's Health Act, ensure that restraint and seclusion will be conducted only by properly trained personnel while accommodating the staffing challenges that facilities face today.

"These protections will safeguard young lives in the future," Secretary Thompson said. "By putting these protections in place now, we should be able to prevent the kinds of injuries and deaths that can be caused by the improper use of restraints in these facilities."

HCFA is the federal agency that administers the joint state-federal Medicaid program. Through Medicaid, federal funding is available for states to pay for inpatient psychiatric services for eligible individuals under 21 years of age in general hospitals, psychiatric hospitals, as well as non-hospital settings, such as psychiatric residential treatment facilities.

This interim final rule will be published in the May 22 Federal Register and will be effective immediately. Comments on the amended language will be considered by HCFA.

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