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Psychiatric Residential Treatment Facility Providers

This page provides basic information about being certified as a Psychiatric Residential Treatment Facility (PRTF) and includes links to applicable laws, regulations, and compliance information. 

The Social Security Amendments of 1972 amended the Medicaid Statute to allow States the option of covering inpatient psychiatric hospitals services for individuals under 21 (psych under 21 benefit).  Originally the statute required that the psych under 21 benefit be provided by psychiatric hospitals that were accredited by Joint Commission on Accreditation of Healthcare Organizations (JCAHO).  In 1976, final regulations were published implementing the psych under 21 benefit.  The regulations allowed the coverage of the benefit in psychiatric facilities that were accredited by JCAHO.  However, JCAHO indicated that this Federal requirement was in conflict with their policy that facilities should seek accreditation voluntarily.  CMS said that the regulatory requirement for JCAHO accreditation could not be removed because it as required by Statute.

In 1984, Congress amended 1905(b), removing the requirement for JCAHO accreditation and adding the requirement that providers of the psych under 21 benefit meet the definition of a psychiatric hospital under the Medicare program as specified in 1861(f) of the Act.  Despite this, CMS did not remove JCAHO accreditation from CMS regulations.  CMS’ reliance on JCAHO accreditation was the only basis for coverage of the psych under 21 benefit in psychiatric facilities other than psychiatric hospitals.  CMS’ decision to retain the requirement for JCAHO accreditation bas based on the fact that Congress gave no indication that it intended to narrow the psych under 21 benefit or alter CMS policy that has been in effect since 1976.

In 1990, the Omnibus Budget Reconciliation Act of 1990 was enacted to specify that the psych under 21 benefit can be provided in psychiatric hospitals that meet the definition of the term in 1861(f) of the Act or in another inpatient setting that the Secretary has specified in regulations.  OBRA 90 provided authority for CMS to specify inpatient settings in addition to the psychiatric hospital setting for the psych under 21 benefit without continuing to require that providers obtain JCAHO accreditation.  Thus, CMS established the PRTF as a separate type of inpatient setting.

In January 2001, a Federal interim final rule was published on the use of restraint and seclusion in PRTFs to safeguard the treatment of child and adolescents under the age of 21.  It established a CoP for PRTFs - §483.350 – §483.376.

Psychiatric Services for Individuals Under Age 21 Benefit

The psych under 21 benefit, at section 1905(a)(16) of the Act, is optional.  The benefit must be provided in all States to those individuals who are determined during the course of an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screen to need this type of inpatient psychiatric care.  Under the EPSDT provision, States must provide any services listed in section 1905(a) of the Act that is needed to correct or ameliorate defects and physical and mental conditions discovered by EPSDT screening, whether or not the service is covered under the State plan.