A Psychiatric Residential Treatment Facility (PRTF) is any non-hospital facility that provides inpatient psychiatric services to Medicaid-eligible individuals under the age of 21. A PRTF must have a provider agreement with the Idaho State Medicaid Agency, be accredited, and meet the federal Regulation requirements in §441.151 through 441.182 and 483.350 Subpart G, governing the use of restraint and seclusion.
The application packet includes the information and documents that must be submitted and approved by the Bureau of Facility Standards prior to initial PRTF certification (items #1 - #3) and resource information related to PRTFs (items #4 - #6) as follows:
Prior to referring to the information below, please take time to review this document for better understanding of the certification process: CMS Enrollment and Certification Roadmap
1. Accreditation. A copy of the facility’s Joint Commission (JC), Commission on Accreditation of Rehabilitation Facilities (CARF), or Council on Accreditation of Services for Families and Children (COA) accreditation survey along with any plan of correction submitted in response to the survey and the letter from the accrediting organization to you verifying the facility’s accreditation as a provider of inpatient psychiatric services for children.
2. Attestations. All attestations must be signed and dated by the facility director and include the following information:
a. Facility General Characteristics: name, address, and telephone number of the facility:
- If the PRTF is located on a campus or co-located with other facilities, please include a map designating the specific location of the PRTF.
b. Facility Specific Characteristics:
- Bed size;
- Number of individuals currently served within the PRTF who are provided service based on their eligibility for the Medicaid Inpatient Psychiatric Services for Individuals Under age 21 Benefit (Psych under 21);
- Number of individuals, if any, whose Medicaid Inpatient Psychiatric Services Under 21 Benefit is paid for by any State other than the State of the PRTF identified in this attestation letter; and
- List all States from which the PRTF has ever received Medicaid payment for the provision of Psych under 21 services.
c. A statement certifying that the facility currently meets all of the requirements of Part 483, Subpart G governing the use of restraint and seclusion;
d. A statement acknowledging the right of the SA (or its agents) and, if necessary, CMS to conduct an on-site survey at any time to validate the facility’s compliance with the requirements of the rules, to investigate complaints lodged against the facility, or to investigate serious occurrences; and
e. A statement that the facility will submit a new attestation of compliance annually and in the event a new facility director is appointed.
3. Fiscal year ending date form.
4. Appendix N - Psychiatric Residential Treatment Facilities (PRTF) Interpretive Guidance.
5. Appendix Q - Guidelines For Determining Immediate Jeopardy.
6. Appendix Z - Emergency Preparedness (EP) requirements.
7. In addition to the application and corresponding processes listed above, please submit the following with your application:
a. Table of Organization. Please specify the number of full-time equivalents in each position.
b. Job descriptions for each of the positions identified in the Table of Organization.
c. Evidence verifying that professionals to be utilized are currently licensed and/or certified in Idaho, as applicable.
d. Evidence of the establishment of educational services.
e. Contracts for physician, psychiatrist, dentist, optometrist/ophthalmologist, registered nurses, licensed practical nurses, pharmacist, occupational therapist, speech language pathologist, audiologist, registered dietician, and/or any other contracted services.
f. Policies and Procedures, sufficient to meet all regulations under the Condition of Participation.
8. Refer to CMS Exhibit 63 for additional document assistance.
When you have completed the application, you may send all documents by mail to:
Department of Health and Welfare
Bureau of Facility Standards
P.O. Box 83720
Boise, ID 83720-0009
PLEASE KEEP A COPY FOR YOUR RECORDS
To become an Idaho Medicaid provider, you must submit an Idaho Medicaid provider enrollment application to Gainwell Technology, Idaho’s Medicaid Management Information Systems (MMIS) Vendor. To submit an Idaho Medicaid provider enrollment application, go to www.idmedicaid.com and register for a trading partner account. A step-by-step user guide can be found by selecting Reference Material, User Guides, New Provider Enrollment Guide. Additional provider enrollment help is available by contacting your Provider Relations Consultant or Provider Services. Contact information can be found at www.idmedicaid.com or call 866-686-4272.
Applying to be an Idaho Medicaid provider is a separate process from federal certification and state licensure.
Medicare/Medicaid reimbursement is not retroactive and usually becomes effective only after your enrollment application is approved, the survey is completed, and you are in compliance with all regulations or have submitted an acceptable plan of correction.
Resources
Regulatory information
450 W State Street, 6th Floor, PTC
Boise, ID 83702-6056
United States