What’s Next?

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 regulations in this controversial area.

• November 1994: HCFA proposes a new rule to establish 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 including standards on seclusion and restraint. The controversial requirement for conducting a face-to-face evaluation 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 rule based on comments regarding the seclusion and restraint standards.

• 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. There is a 60-day comment period.

• January 2001: The Bush administration postpones the effective date of March 23 for 60 days to review the interim final rule. Possible outcomes include withdrawing the rule, letting it become effective without further changes, or adding changes within one year.