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CMS and Joint Commission

Centers for Medicare & Medicaid Services (CMS) Rules for Restraint and Seclusion

Information on 42 CFR 482: Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients' Rights

The Federal Department of Health and Human Services Centers for Medicare & Medicaid Services has rules in place regarding the use of restraint and seclusion in all Medicare and Medicaid participating hospitals. These rules specify that training requirements include:

  • Demonstrated competency in the application of restraints.
  • Periodic refresher training.
  • Training in the use of nonphysical intervention skills.
  • Information about and recognition of symptoms of patient distress, such as positional asphyxia.


When CMS calculated the implementation costs in a hospital setting, it used CPI's nationally recognized Nonviolent Crisis Intervention® Instructor Certification Program.

The Joint Commission

Recent changes to Elements of Performance
Effective July 2009, The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), implemented Elements of Performance (EP) regarding the use of physical restraint and seclusion. These changes were made to help align Joint Commission Standards more closely with CMS regulations, help clear up questions related to behavioral restraints and medical restraints, and dictate new requirements for a hospital’s documentation and policies and procedures regarding restraint and seclusion. Additionally, the Joint Commission EPs provide specific staff training requirements including:

  • Strategies to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion.
  • Use of nonphysical intervention skills.
  • Methods for choosing the least restrictive intervention based on an assessment of the patient’s medical or behavioral status or condition.
  • Safe application and use of all types of restraint or seclusion used in the hospital, including training in how to recognize and respond to signs of physical and psychological distress.


CPI Can Help!

Restraint and seclusion within a health care setting is a critical issue. Since 1980, more than 8 million professionals—including tens of thousands in the health care field—have participated in CPI’s Nonviolent Crisis Intervention® training and learned to safely manage disruptive behavior at the earliest possible stage through proven verbal intervention strategies. The program also teaches safe, nonharmful emergency restraint techniques to be used only as a last resort, when an individual is a danger to self or others.

  • See how CPI's Nonviolent Crisis Intervention® Instructor Certification Program aligns with the CMS rules.
  • Explore how CPI’s Nonviolent Crisis Intervention® Instructor Certification Program aligns with Joint Commission Standards.
  • View a list of upcoming Nonviolent Crisis Intervention® training programs.
  • Learn how CPI can deliver training on site at your hospital.
  • Read testimonials and success stories from hospitals who have implemented the Nonviolent Crisis Intervention® program.