Psychiatric Residential Treatment Facilities (PRTF) will provide active treatment to children and youth under age 21 with complex mental health conditions. This is an inpatient level of care provided in a residential facility rather than a hospital. PRTFs deliver services under the direction of a physician, seven days per week, to residents and their families, which may include individual, family and group therapy. A resident’s plan of care may also include arranged services or specialty therapies, such as occupational therapy, physical therapy or speech therapy.
PRTF discharge planning begins at the time of admission and requires coordination with the individuals, their families and community-based service providers. Comprehensive discharge planning is essential for individuals to successfully transition to home, school and community as soon as possible.
PRTF services will be funded by Minnesota Health Care Programs (MHCP), which include Medical Assistance and MinnesotaCare for eligible individuals. This inpatient services benefit to children and youth under the age of 21 (psych under 21 benefit) is based on medical necessity.
All the following criteria must be met for admission to a PRTF:
A mental health diagnosis as defined in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression, or a finding that the individual is a risk to self or others.
A functional impairment and a history of difficulty functioning safely and successfully in the community, school, home, or job; an inability to adequately care for one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill the individual's needs.
Psychiatric residential treatment is required to improve the individual’s condition or prevent further regression.
Other community-based mental health services have been exhausted and/or cannot provide the level of care needed.
A qualified mental health professional may make a referral to a PRTF. A qualified mental health professional must meet requirements outlined in MN Statutes, section 245.4871, subd. 27, clauses (1) to (6). Other members of an individual’s treatment team, such as case managers and other service providers, may have a role in facilitating the referral and providing information to support the referral. Please refer to the MHCP Manual for more detailed requirements and instructions for authorization and billing for PRTF services.
Licensed mental health providers referring Medicaid (fee-for service) recipients must do the following:
Submit DHS Form 7696, and all supporting documentation listed above, to the state’s medical review agent via KEPRO’s Atrezzo Portal (preferred) or fax.
A review determined to meet medical necessity will remain valid as long as the diagnostic assessment is current and there are no significant changes in symptoms and/or needs of the child/youth.
Coordinate with the PRTF facility regarding intake and admissions, and anticipated admission date.
For individuals with coverage other than Medicaid fee-for-service, the referring licensed mental health professional will coordinate referral and admission with the PRTF, and follow any authorization requirements of the individual’s health plan or payer.