Evolution of S&R Regulations

There are too many conflicting standards on the use of seclusion and restraint in hospitals and residential treatment facilities, says APA. Below is a timeline of government regulatory and legislative efforts in this controversial area.

• November 1994: The Health Care Financing Administration (HCFA) proposes a new rule to establish federal standards for psychiatric residential treatment facilities with limits on physical and chemical restraints. The rule never becomes final.

• July 1999: HCFA issues an “interim final rule” establishing Medicare and Medicaid conditions of participation (CoP) for hospitals that include standards on seclusion and restraint. The controversial requirement for conducting a face-to-face evaluation by a physician or licensed independent practitioner within one hour of ordering seclusion or restraint is imposed. There is a 60-day comment period.

• August 1999: HCFA puts into effect the hospital CoP without revising the one-hour rule.

• October 2000: The Children’s Health Act becomes law. It requires federally funded health care facilities to limit the use of seclusion and restraint to emergency situations to ensure the safety of the patient or others, among other provisions.

• January 2001: The Joint Commission on the Accreditation of Healthcare Organizations and the Council on Accreditation for Children and Family Services put into effect their revised standards on seclusion and restraint for behavioral health care programs.

• January 2001: HCFA issues its interim final rule on seclusion and restraint for Medicaid-funded psychiatric residential treatment facilities treating youth. It allows a 60-day comment period.

• January 2001: Soon after the Bush administration takes office, it postpones the effective date of March 23 for 60 days to review the interim final rule. Possible outcomes include withdrawing the rule, allowing it to become effective without further changes, or implementing it with changes within one year.

• May 2001: HCFA issues a revised interim final rule without some of the more burdensome staffing and reporting requirements. The definition of physical restraint no longer includes temporary holds or escorting.