The Joint Commission (JCAHO) is currently in the process of applying for deeming authority from the Centers for Medicare & Medicaid Services (CMS). JCAHO must have such authority to enable hospitals to obtain “deemed status” through JCAHO accreditation. “Deemed status” means that the hospital (i) has met the Medicare Conditions of Participation for hospitals (CoPs), and (ii) is eligible for reimbursement under the Medicare and Medicaid programs. In the past, JCAHO was not required to apply for deeming authority because the amendments to the Social Security Act enacted in 1965 automatically granted JCAHO such authority. On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008, which requires all accrediting bodies, including JCAHO, to apply to CMS for deeming authority. JCAHO’s current deeming authority for hospitals remains in effect during the application process.  

In January 2009, JCAHO posted various new and revised requirements for hospitals as part of its application for deeming authority. Many of these requirements, which JCAHO plans to implement on July 1, 2009, involve changes to the restraint and seclusion standards and elements of performance. JCAHO revised the restraint and seclusion requirements to better conform to the CoPs. While JCAHO has indicated that further changes may be forthcoming, the revised standards currently in effect are as follows:

  • The hospital uses restraint or seclusion only when such use can be clinically justified or when warranted by patient behavior that threatens the physical safety of the patient, staff, or others;
  • The hospital uses restraint or seclusion safely;
  • The hospital initiates restraint or seclusion based on an individual order;
  • The hospital monitors patients who are restrained or secluded;
  • The hospital has written policies and procedures that guide the use of restraint and seclusion;
  • The hospital evaluates and re-evaluates the patient who is restrained or secluded;
  • The hospital continuously monitors patients who are simultaneously restrained and secluded;
  • The hospital documents the use of restraint or seclusion;
  • The hospital trains staff to safely implement the use of restraint or seclusion; and
  • The hospital reports deaths associated with the use of restraint and seclusion.

In addition to these standards, there are numerous elements of performance that hospitals will need to comply with to obtain JCAHO accreditation for deemed status purposes. Hospitals that use JCAHO accreditation for deemed status should review their restraint and seclusion policies and practices to ensure compliance.