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CMS Issues Seclusion & Restraint Guidance
December 23, 2003

The Center for Medicare and Medicaid Services (CMS) has issued guidance on implementing regulations for the use of seclusion and restraint in childrens' residential facilities. On December 11 CMS issued guidance for its state survey agencies on their responsibility to enforce the interim final CMS restraint and seclusion regulations for psychiatric residential treatment facilities (RTFs) for persons under 21. The guidance is available on the CMS web site at www.cms.hhs.gov/medicaid/survey-cert/sc0413.pdf.

The guidance addresses in detail the state agencies' obligations to enforce the regulations' requirements on reporting of incidents, as well as provisions on complaints and monitoring of facilities. CMS states it expects the final rule to be issued in the summer of 2004. It also provides interpretative guidelines for RTFs on the application of the regulations. See the guidance for regulation section 483.374(b) for details on reporting on deaths, serious injuries, and suicide attempts.

The directive states that survey agencies are expected to begin, in March 2004, on-site "validation" inspections of 20 percent of all facilities each year and complaint investigations. Facilities that fail to report a death or who are otherwise found out of compliance with the regulations will be terminated from the Medicaid program. This is apparently the first formal detailed directive to the state agencies regarding their enforcement duties for these regulations.

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