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HCFA's new rule also sets forth a Condition of Participation (CoP) governing the use of restraint and seclusion that psychiatric residential treatment facilities must meet to provide, or to continue to provide, Medicaid inpatient psychiatric services to individuals under age 21.

A September 1999 General Accounting Office (GAO) report documented the dangers associated with the inappropriate use of restraint and seclusion, noting especially that children are subjected to restraint and seclusion at higher rates than adults and are at greater risk of serious injury or death as a result of improper restraint and seclusion practices.

The CoP established by HCFA's rule sets forth a series of standards that a facility must meet to help ensure each resident's physical and emotional health and safety. The CoP acknowledges each resident's right to be free from restraint or seclusion, of any form, and limits the use of restraint or seclusion to only emergency safety situations. The CoP imposes age-specific time limits for restraint or seclusion orders, and prohibits the simultaneous use of restraint and seclusion.

"People with serious mental illnesses, especially children and adolescents, are among the country's most vulnerable citizens," Robert A. Berenson, M.D., HCFA's acting deputy administrator, noted. "These added requirements will better protect children and adolescents from the dangers associated with the use of restraint or seclusion."

HCFA is the federal agency that administers the joint state-federal Medicaid program and is committed to protecting the health and welfare of all beneficiaries, including people -- young and old -- who have a serious mental illness. 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.

Psychiatric residential treatment facilities are rapidly replacing hospitals in treating children and adolescents with psychiatric disorders and are generally a less restrictive alternative to a hospital for treating those whose illnesses are less acute but who still require a residential environment.

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