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Statement of Need: The standards were developed to eliminate the risk to children and adolescents from inappropriate restraint and seclusion that were substantiated by reports of deaths and injuries that occurred in these facilities. This final rule will clarify and revise the regulations in response to public comments that were received on the previous interim final rules.

Summary of the Legal Basis: Section 1902(a)(9)(A) of the Social Security Act (the Act) requires the State health agency or other State medical agency to establish and maintain health standards for private and public institutions in which recipients of medical assistance, under the State plan, may receive care or services. Section 1905(h) of the Act defines the term "impatient psychiatric hospital services for individuals under age 21" as inpatient services that are provided in an institution (or distinct part hereof) that is a psychiatric hospital or in another in patient setting that the Secretary has specified in regulations. In this final rule, we are defining "psychiatric residential treatment facilities" as an inpatient setting in conformity with the definition of an institution as set forth in section 1905(h)of the Act. The Children's Health Act (CHA) of 2000 (Pub. L. 106-310), which amended the Public Health Section of the Act to require the health care facilities receiving support in any form from any program supported in whole or in part with funds appropriated to any Federal department or agency shall protect and promote the rights of each resident of the facility, including the right to be free from any restraints or involuntary seclusion imposed for purposes of discipline or convenience. The Children's Health Act permits the Secretary to issue regulations that afford residents greater protections regarding restraint and seclusion than the standards published in the new law. Our final rule provides greater protections than those required in section 3207 of the Children's Health Act.

Alternatives: None.

Anticipated Costs and Benefits: The average costs for psychiatric residential treatment facilities to implement this rule are estimated to be around $65 million per year for the first 5 years. We believe that requirements of this rule will have a direct impact on the use of restraint and seclusion in residential treatment facilities. Specifically, we are limiting the use of restraint and seclusion to emergency safety situations only and have specifically defined an emergency safety situation for purposes of this rule. By limiting the use of restraint and seclusion we expect to better protect residents from the use of restraint and seclusion as a means of coercion, discipline, staff convenience, or retaliation.

Risks: There is the potential for great risks to facility residents if the current regulations are not revised and reports of inappropriate restraint and seclusion practices continue.