Medicaid Amended Interim Final Rule covering the Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities Providing Psychiatric Services to Individuals Under Age 21

May 23, 2001

The Health Care Financing Administration (HCFA) published in the May 22, 2001, Federal Register, an amended interim final rule for the use of restraints and seclusion in psychiatric residential treatment facilities that provide Medicaid’s inpatient psychiatric services for individuals under age 21.

Through the joint efforts of CWLA, our member agencies, key Members of Congress, and others, our concerns regarding the unintended consequences for children and youth and the financial burden associated with implementation of this rule were heard. Preliminary review finds the amended rule attempts to address the concerns submitted in comments on the original interim final rule (January 22, 2001) by further clarifying which facilities are affected by the rule; revising the reporting requirements; and broadening the personnel requirements for those permitted to restrain and seclude residents.

In addition, the amended rule requires any use of restraints and seclusion in a covered Medicaid psychiatric facility to be performed only on an order and under the supervision of a physician, a registered nurse, or other licensed practitioner, permitted by the state and facility to issue orders. HCFA made these requirements consistent with those in the Children’s Health Act of 2000, which mandates that restraints and seclusion only be applied by properly trained staff. Additionally, these requirements addressed the concerns regarding the shortage of personnel (e.g., registered nurses and board-certified psychiatrists).

The amended interim final rule takes affect May 22, 2001. Comments regarding the amended interim final rule will be considered if received by at the address below, no later than 5 p.m. on July 23, 2001. Written comments (one original and three copies) may be mailed to the Health Care Financing Administration, Department of Health and Human Services, Attention: HCFA-2065-IFC2, P.O. Box 8010, Baltimore, MD 21244-8010.

To view a complete copy of the amended interim final rule go to, type in 02/22/2001 and the search term restraint. CWLA’s March 15 comments to HCFA and Part H and I of the Children’s Health Act of 2000 may be viewed at secres010315.htm.

While we are pleased with our initial review, a more detailed analysis of this interim final rule is being prepared and will soon be available. If you should have any questions regarding the amended rule, please contact Lloyd B. Bullard at 202/942-0280 or e-mail: