93.789: Alternatives to Psychiatric Residential Treatment Facilities for Children

93.789

Inactive

Centers for Medicare and Medicaid Services (CMS) [HHS]

July 23, 2013

July 18, 2012

Over the last decade, Psychiatric Residential Treatment Facilities (PRTFs) have become the primary provider for youth with serious emotional disturbances requiring an institutional level of care. However, since they are not recognized as hospitals, nursing facilities or intermediate care facilities for the mentally retarded, many States have been unable to use the 1915(c) waiver authority to provide home and community-based alternatives to care, which would keep the youth in their homes and with their families. Section 6063 of the Deficit Reduction Act of 2005 addresses this issue by providing up to $218 million to up to 10 States to develop demonstration programs that provide home and community-based services to youth as alternatives to PRTFs. CMS anticipates awarding each successful applicant between $5 and $60 million. The PRTF Demonstration is authorized for up to 5 years. Payments may not be made to States after fiscal year 2011. CMS will review and approve each State's Implementation Plan prior to allowing States to access funds for Federal reimbursement of services under this grant. Section 6063 also provides $1 million for a National Demonstration Evaluation.

A - Formula Grants (Apportionments)

Any single State Medicaid Agency, State Mental Health Agency, or instrumentality of the State may apply for this Demonstration Grant. Only one application can be submitted for a given State. By State we refer to the definition provided under 45 CFR 74.2 as any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. By territory or possession we mean Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands.

The level of care for Medicaid eligible individuals for this demonstration at a minimum must be under the age of 21 and require the need for a PRTF as defined in the State's Medicaid State Plan. For the purposes of this demonstration, youth are defined as any child, adolescent or young adult under the age of 21. States shall ensure that each participant under the demonstration meets this level of care criterion to participate in the demonstration. Further, States may elect to add additional criteria to carve out or target a specific sub-population to receive home and community-based services under this demonstration. As a part of the application process, States shall submit a copy of the level of care assessment used to assess eligibility for participation in this demonstration. PRTFs are defined as any non-hospital facility with a provider agreement with a State Medicaid Agency to provide the inpatient services benefit to Medicaid- eligible individuals under the age of 21 (CFR 42 441.150 - 441.182). The facility must be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or any other accrediting organization with comparable standards recognized by the State. Additionally PRTFs must comply with Conditions of Participation on the use of restraint and seclusion (CFR 483.350 - 483.376).