Monitoring of Restraint Compliance for PRTFs

December 8, 2006

DPW-DOH Memorandum of Understanding
In September the Departments of Health (DOH) and Public Welfare (DPW) completed a Memorandum of Understanding (MOU) Regarding Psychiatric Residential Treatment Facilities. Richard Lee, deputy secretary for quality assurance, DOH, provided PCPA with a copy of the MOU. He and his senior staff met with the association to discuss the implementation and implications of the role of the department and the collaboration between the departments and program offices. Key elements of the MOU include:

• Assignment of responsibility to the Department of Health for validation and compliance surveys of Psychiatric Residential Treatment Facilities (PRTF) as defined in federal regulations 42 CFR § 483.350 – 483.376 related to restraint and seclusion.
• Defining a PRTF, using federal standards, as a psychiatric inpatient treatment setting that is not a hospital and is accredited by JCAHO, CARF, COA, or another accrediting organization with comparable standards that is recognized by the Department of Public Welfare.
• Agreement that DOH receive and investigate reports of serious occurrences, including a resident’s death, a serious injury to a resident, and a resident’s suicide attempt.
• A commitment by DOH and DPW to, as soon as reasonably possible, issue a joint provider bulletin informing PRTFs of the respective roles and responsibilities of DPW and DOH.
• DPW and DOH will develop protocols and procedures to coordinate reviews to maximize efficiency and reduce duplicative effort and conflicting outcomes.
• DOH will conduct an annual attestation survey of 20 percent of all PRTFs.
• DPW will accept validation or complaint survey reports from DOH, but DPW will be responsible for imposing sanctions related to a finding of regulatory non-compliance.

Department of Health Compliance Resources
The Department of Health Division of Intermediate Care Facilities (ICF) has been assigned responsibility for the survey and investigation activity related to PRTF services. As a resource to PRTF programs, the division has established a web page on the DOH web site with critical information and links. This information is most easily accessed by logging onto the DOH web site and typing "ICF" in the site search engine or directly at www.dsf.health.state.pa.us/health/cwp/view.asp?a=189&q=237226. The site provides links to federal regulations and reporting requirements, guidance, and worksheets and lists all Pennsylvania’s PRTFs and the DOH regional assignment. Contact information for regional ICF division offices is also available.

Collaboration With Providers
PCPA will forward general questions about this new process and regulatory compliance to the Division of Intermediate Care Facilities and share responses with providers. Deputy Secretary Lee has agreed to arrange regular meetings with staff of the provider associations and will make staff available to meet with the RTF work group at a meeting to be scheduled in January or February.

For additional information or questions, contact Connell O'Brien.