330.1137a Psychiatric residential treatment facilities (PRTFs) for Medicaid recipients; request for proposals for providers; reimbursement requirements; rules; evaluation
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330.1137a Psychiatric residential treatment facilities (PRTFs) for Medicaid recipients; request for proposals for providers; reimbursement requirements; rules; evaluation and revocation.
Sec. 137a.
(1)The department shall, subject to appropriation of sufficient funding, establish PRTFs for Medicaid recipients under age 21 as described under 42 CFR 441.151 to 441.184.
(2)The department shall select PRTF providers through a request for proposals process. Public or private providers, including, but not limited to, those providing state-operated services, may respond to the request for proposals.
(3)To be eligible for reimbursement from the department, a PRTF must meet all of the following requirements:
(a)Be certified by the department.
(b)Be accredited by the Joint Commission, Commission on Accreditation of Rehabilitation Facilities, or Council on Accreditation.
(c)Be enrolled in the Medicaid Management Information System.
(d)Any other requirement the department considers appropriate and necessary to provide PRTF services and comply with 42 CFR 441.151 to 441.182.
(4)The department may establish a Medicaid policy and promulgate administrative rules necessary to implement this section. When promulgating administrative rules or developing the criteria by which a PRTF will be selected or certified under this section, the department shall consider both of the following:
(a)The geographic need and appropriateness for PRTF services, including, but not limited to, all of the following:
(i)Prioritizing the selection and certification of PRTFs in areas of this state lacking inpatient psychiatric services for individuals under age 21.
(ii)Avoiding concentration of PRTFs in any particular community or area of this state to ensure the easiest possible access for families or guardians to visit patients when appropriate.
(iii)Consideration of the availability of community resources sufficient to support a PRTF and its patients, including, but not limited to, the capacity of public safety and emergency medical response services and proximity to ancillary medical providers.
(b)The capacity of a PRTF to provide care that results in the successful integration of patients back into the community within 60 to 120 days after admission to the PRTF, including a reintegration with family whenever possible and appropriate.
(5)The department shall evaluate each selected PRTF no less than every 2 years based on the criteria developed by the department, including the criteria described in subsection (4)(a) and (b). The department may revoke the selection and certification of, or take corrective action considered necessary against, any PRTF that is determined to no longer be needed or appropriate under the criteria described in subsection (4)(a) or found not to be in compliance with the criteria described in subsection (4)(b). This subsection does not limit the ability of the department to take corrective action or to revoke the selection or certification of a PRTF for other good cause at any time.
History: Add. 2020, Act 285 , Eff. Mar. 24, 2021