Psychiatric Residential Treatment Facilities (PRTF) – Citations

2830 – Psychiatric Residential Treatment Facilities (PRTF) – Citations and Definitions (Rev. 132; Issued: 01-16-15, Effective: 01-16-15, Implementation: 01-16-15) 2830A – Citations Sections 1905(a)(16) and (h) of the Act provide that inpatient psychiatric services for individuals under age 21 include only inpatient services that are provided in an institution (or distinct part thereof) that is a psychiatric hospital as defined in section 1861(f) of the Act or in another inpatient setting that the Secretary has specified in regulations. Additionally, the Children’s Health Act of 2000 (Pub. L. 106–310) imposes procedural reporting and training requirements regarding the use of restraints and involuntary seclusion in facilities, specifically including facilities that provide inpatient psychiatric services for children under the age of 21 as defined by sections 1905(a)(16) and (h) of the Act. (42 CFR 483.350(a)). Condition of Participation (CoP). The Condition of Participation for PRTFs is contained in 42 CFR Part 483, Subpart G: Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under 21. Appendix N of this manual contains the Interpretive Guidelines for surveyors. 2830B – Definitions A Psychiatric Residential Treatment Facility (PRTF) is defined as a facility other than a hospital, that provides psychiatric services, as described in subpart D of part 441 of this chapter, to individuals under age 21, in an inpatient setting. Sections 441.151, in subpart D of 42 CFR indicates that PRTFs must be accredited by the Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation of Services for Families and Children (COA), or by any other accrediting organization with comparable standards that is recognized by the State. PRTFs, as indicated in §483.374 must also have either a current provider agreement with the State Medicaid agency or if enrolling as a Medicaid provider must execute a provider agreement with the State Medicaid agency. Inpatient Psychiatric Services for Individuals Under age 21 Benefit. – Inpatient psychiatric services for individuals under 21 is a Medicaid benefit as provided by section 1905(a)(16) of the Social Security Act, the provision of these services is an optional benefit for individual states. Although a state may choose to or not to offer PRTF services in its state plan, the benefit must be provided in all States to those individuals who are determined during the course of an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screen to need this type of inpatient psychiatric care. Under the EPSDT provisions at section 1905(r)(5) of the Act, States must provide any service listed in section 1905(a) of the Act that is needed to correct or ameliorate defects and physical and mental conditions discovered by EPSDT screening services, whether or not the service is covered under the State plan. Condition of Participation for the Use of Restraint and Seclusion. – PRTFs must comply with the requirements of 42 CFR 483.350, subpart G in order to participate in the Medicaid program. The interpretive guidelines for the Condition of Participation may be found in Appendix N and include discussion of the following eleven standards of the Condition: • General requirements for psychiatric residential treatment; • Resident protections; • Orders for the use of restraint or seclusion; • Consultation with treatment team physician; • Monitoring of residents in and/or immediately following restraint or seclusion; • Requirements for notifying parents or legal guardians; • Application of time out; • Post-intervention debriefing; • Medical treatment for injuries resulting from an emergency safety intervention; • Facility reporting requirements; • Facility’s responsibility in educating and training its staff. Emergency safety situation means unanticipated resident behavior that places the resident or others at serious threat of violence or injury if no intervention occurs and that calls for an emergency safety intervention as defined in this section. Emergency safety intervention means the use of restraint or seclusion as an immediate response to an emergency safety situation. Minor means a minor as defined under State law and, for the purpose of this as defined in §483.352, includes a resident who has been declared legally incompetent by the applicable State court. Resident means an individual under age 21(as described in subpart D of §441.151) receiving psychiatric treatment in a PRTF. Restraint means a “personal restraint,” “mechanical restraint”or“drug used as a restraint,” as defined in this section. Seclusion means the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving. Serious injury means, any significant impairment of physical condition of resident as determined by qualified medical personnel. This includes but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else. Staff means individuals who participate in caring for the resident, who have the responsibility for managing a resident's treatment and who are employed by the facility on a full-time, part-time, or contract basis. Time out means the restriction of a resident for a period of time to a designated area from which the resident is not physically prevented from leaving, for the purpose of providing the resident an opportunity to regain self-control. Drug used as a restraint means any medication that is administered to manage a resident's behavior, which may have temporary effect of restricting the resident's freedom of movement; and is not a standard or routine treatment for the resident's medical or psychiatric condition.