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Expected PRTF Regulation Changes
March 23, 2009

During a special meeting of the Office of Mental Health and Substance Abuse Services (OMHSAS) Children’s Advisory Committee, OMHSAS staff reviewed the key changes that are embedded in the current draft of the Psychiatric Residential Treatment Facility (PRTF) regulations. While the proposed regulations are still being reviewed by the Department of Public Welfare prior to publication and public comment, OMHSAS has provided PCPA with a preview of the potential changes.

Overview of Proposed Changes
These regulations will be applicable to accredited (JCAHO, COA, or CARF) facilities.

General Requirements (§§ 31.11 – 31.23.) 

  • A maximum of 12 beds to a unit.
  • Reportable incidents have been expanded to include drugs used as a restraint. 

Child Rights (§§ 31.31 – 31.34.) 
Additional child rights beyond those required in Chapter 3800:

  • The right to be free from restraint or seclusion, of any form, used as a means of coercion, discipline, convenience, or retaliation. 
  • The right for the child to advocate for his or her needs without retaliation or removal from the program.
  • The right to a clean, healthy, and comfortable environment.  

Family Participation (§§ 31.41 – 31.44.)

  • Requires RTF providers to make efforts to include families in the planning and implementation of their child’s treatment by providing adequate information assisting with scheduling visits, therapy sessions, travel arrangements, and medical appointments.
  • Providing adequate comfortable space for visiting.

Staffing (§§ 31.51 – 31.61.)

  • Higher expectations for staff qualifications, education, and experience.
  • Higher staffing ratios.
  • Four to one for direct care staff.
  • Two Mental Health Professionals for every 12 children.
  • More clinically oriented training topics than the health and safety focused Chapter 3800 requirements. 
  • Requirement for a family advocate pro-rated as one full-time advocate for every 48 children.

Medications (§§ 31.181 – 31.190.)    

  • More stringent rules for storage, use, and administration of medications with more emphasis on the information provided to the child and family regarding the effects and side effects of psychotropic medication.
  • The administration of medications is limited to licensed medical personnel with a few exceptions. 
  • A new requirement is added to report to the department on a semi-annual basis the use of multiple psychotropic medications simultaneously or any antipsychotic medications for an individual child.

Restrictive Procedures (§§ 31.201 – 31.206.)    

  • Requirement for all RTFs to use de-escalation approaches and other alternatives to coercive techniques in order to reduce or eliminate the need to use restrictive procedures includes a ban on prone restraint.
  • All RTFs are required to develop a written plan with goals and objectives and time frames to establish a trauma informed approach which establishes a restraint free environment within the facility.

Services (§§ 31.221 – 31.230.)  

  • Requirement to individualize the planning with an emphasis on the behavioral health treatment needs of the children.
  • RTFs are required to have verification from the Local Education Agency (LEA) in which the facility is located stating that the facility has consulted with the LEA; that the LEA has acknowledged its obligation to educate children who are attending the facility in the most integrated setting and in the public school whenever appropriate; and that the LEA will meet the education, special education, and related service needs of those children.

Payment for Services (§§ 31.281- 31.351)

  • Payment requirements for RTFs licensed under this chapter to be reimbursed for the provision of the treatment services are outlined with the expectation that the rates will take into consideration the new requirements.
  • Although the per diem rates for each provider will increase based on added requirements, it is anticipated that with improved quality of care there will be shorter lengths of stay and therefore will be cost neutral.

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