Revised Medicare Conditions of Participation

The Centers for Medicare & Medicaid Services published a final rule in the Dec. 8, 2006, Federal Register revising the restraint and seclusion section in the hospital conditions of participation §482.13 Patient Rights. The revised CoPs eliminate the separate sections for behavioral health and medical and surgical patients. Now, the CoPs specify separate requirements for violent and self-destructive patients and for nonviolent and nonself-destructive patients. The revised CoPs also permit specially-trained nurses and physician assistants to perform the one-hour face-to-face evaluation, which was required under the behavioral health section.

The rule also establishes new training requirements for staff on restraint and seclusion use and expands the death reporting requirements to include deaths that occur within one week after using restraint or seclusion.

MHA has prepared a side-by-side comparison of the old and revised CoPs, Missouri rules and statutes and the Joint Commission standards to assist hospitals with implementation of the revised rules.

Because the CMS has not updated the CoPs in the State Operation Manual, the revised hospital CoP 482.13 Patient Rights is available online.

These tools are being distributed solely for informational purposes and are not intended to serve as an interpretation to the regulations. The Missouri Department of Health and Senior Services, the CMS and the Joint Commission are responsible for interpreting these regulations.

The restraint and seclusion CoPs are applicable for alll hospitals, including short-term, psychiatric, rehabilitation, long-term, children and alcohol/drug treatment facilities that receive Medicaid and Medicare funds. They only apply to the distinct part psychiatric and rehabilitation units of critical access hospitals as CAHs have separate CoPs.

Restraint use in swing-beds used for long-term care residents is subject to §483.13(a).

If you have any questions, please contact Sharon Burnett, vice president of licensure, regulation and accreditation, at 573/893-3700, ext. 1304 or sburnett@mail.mhanet.com.