21(Psych Under 21 Benefit) in Out-of-State Psychiatric Residential Treatment
• A Medicare or Medicaid-certified psychiatric hospital;
• A general hospital with an inpatient psychiatric program accredited by a national accreditation organization (AO) whose hospital accreditation program has been approved by the Centers for Medicare & Medicaid Services (CMS); or
• A PRTF that is Medicaid-certified.
• Ongoing issue: States that choose to send children out-of-State to receive the Psych Under 21 Benefit must ensure that these patients receive services in facilities that are Medicaid-certified. Currently, there are instances where children are being transferred out of their home State to receive these services in facilities that are not certified as PRTFs. This is occurring in situations where the Medicaid State Plan for the receiving State does not include PRTF services.
• State Survey Agency Activity: If the transferring State Medicaid Agency (SMA) wishes to enter into a PRTF agreement with a facility located outside its State, they must make arrangements for the survey of the facility for compliance with applicable regulations. They may make these arrangements with any State Survey Agency (SA). The SA that performs the survey assumes the responsibility for entering the associated data into ASPEN and ensures that re-certification surveys occur at five (5) year intervals.