Final Public Notice for Psychiatric Residential Treatment Facility (PRTFs)
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding Psychiatric Residential Treatment Facility (PRTFs) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Effective on or after July 1, 2017, the SCDHHS will amend the South Carolina Title XIX State Plan to include PRTF services and providers in the Coordinated Care benefit provided by SCDHHS' contracted Managed Care Organizations (MCOs). MCO members will access PRTF services through the MCO plan to which they are assigned. Individuals not assigned to an MCO will continue to access PRTF services through the SCDHHS Medicaid fee-for-service benefit. PRTFs serve beneficiaries 21 years of age and younger.
SCDHHS anticipates that the carve-in of PRTF services will initially be budget neutral, but will ultimately lead to cost savings through increases in coordination of care and better utilization management and review. However, the Department will also rebase PRTF rates based upon the most recent cost report data available (2015), applying a trend factor using CMS Market Basket data, and excluding any ancillary services that may have been provided by individual practitioners/providers/suppliers and reflected in the 2015 PRTF reports. The ancillary services incurred by SC Medicaid PRTF beneficiaries effective on or after July 1, 2017 will be provided under arrangement with contracted enrolled providers. The rate actions listed above are anticipated to improve access for beneficiaries and carry a projected annualized cost of approximately $1.5 million (total dollars).
In addition to adding PRTF services to the coordinated care benefit, SCDHHS plans to include a therapeutic leave benefit, Therapeutic Home Time, as a covered service. Beneficiaries may receive up to fourteen days of Therapeutic Home Time per fiscal year. Facilities will receive a full per diem for Therapeutic Home Time as part of a therapeutic plan to transition the youth to a less restrictive level of care. Therapeutic Home Time is expected to carry a projected annualized cost of approximately $359,000 (total dollars). In the future, savings are expected due to shorter stays and fewer readmissions in PRTF associated with greater family and community involvement in treatment.
Copies of this notice are available at each county SCDHHS office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Behavioral Health, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between 9 a.m.-5 p.m.