The U.S. Health Care Financing Administration (HCFA) recently issued interim interpretive guidelines for Medicare's Condition of Participation (COP) for Hospitals on Patients' Rights (42 CFR Section 482.13). The guidelines relate to HCFA regulations on patients' rights that were published in the July 2, 1999, Federal Register, and became effective August 2, 1999. GNYHA Summary: GNYHA has prepared a summary of the guidelines, which include requirements for the use of restraints and seclusion, with a focus on the provisions that have been of concern to GNYHA member hospitals. The full, 31-page interim interpretive guidelines can be accessed at HCFA's Web page, www.hcfa.gov/quality/4b.htm.
Use of Restraint and Seclusion: The interim interpretive guidelines provide favorable resolution of several issues related to the use of restraints and seclusion that were addressed both in GNYHA's written comments to HCFA and in subsequent discussions with HCFA staff. HCFA requires that the need for chemical and physical restraints be based on an individual assessment of the patient and that documentation in the patient's medical record support the intervention used and indicate the consideration or use of less restrictive measures. Regarding chemical restraints, the guidelines clarify that medications that are part of the patient's regular drug regimen (including PRN, or "as needed," medications) are not considered chemical restraints, even if their purpose is to control ongoing behavior. The interpretive guidelines also expand the definition of Licensed Independent Practitioner (LIP) in a way that will permit physicians, including unlicensed residents, nurse practitioners, and physician assistants, to fulfill the LIP functions in New York State, provided they are afforded these privileges by the hospital. It should be noted, however, that psychiatric units licensed by the New York State Office of Mental Health are required to have all orders for restraint or seclusion, as well as patient assessments, completed by a physician. Finally, GNYHA confirmed that, while the intent behind the regulation is to notify the attending or admitting physician as soon as possible when the use of restraints or seclusion is initiated, HCFA recognizes that immediate notification may not always be possible -- for instance, on weekends, evenings or nights, or during vacations. Under those circumstances, the physician who is covering for the attending or admitting physician is considered to be the "treating physician" for the purpose of the regulation.
Upcoming Briefing: GNYHA will hold an executive briefing in the near future regarding the interim interpretive guidelines, and will notify members when these plans are finalized. In the meantime, please call Patricia O'Brien at GNYHA if you have questions regarding the Medicare COP on Patients' Rights. If you would like to receive a copy of GNYHA's summary of the interpretive guidelines, call Anita Wall at GNYHA.