On Friday, September 20, the Centers for Medicare & Medicaid Services (CMS) provided guidance on whether or not the new classification of Quality Residential Treatment Programs (QRTPs) will fall under the Medicaid classification as an Institutions for Mental Diseases (IMDs). There has been great concern that the new QRTP standards would cause these same child welfare residential facilities to be considered an IMD. If the state Medicaid agency determines that the facility is an IMD, Medicaid funding would not be available for any Medicaid services provided inside or outside of the QRTP to Medicaid eligible children residing in the QRTP, unless one of the two exceptions to the IMD exclusion applies.
The guidance doesn’t appear to clear the issue up. According to the guidance, “CMS has not made a determination that all QRTPs will be IMDs; rather, there are several options for states to consider regarding QRTPs”
According to the guidance an IMD is hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases including medical attention, nursing care, and related services. There are two exceptions to the IMD exclusion: an inpatient hospital services, nursing facility services, and intermediate care facility services for people 65 or older or an inpatient psychiatric hospital services for individuals under age 21 furnished by a psychiatric hospital, a general hospital with a psychiatric program or an accredited Psychiatric Residential Treatment Facility (PRTF).
The issue becomes more complicated in the way that Medicaid and child welfare agencies count beds. Some facilities and agencies may have multiple campuses. Generally speaking, Medicaid would bundle all these beds as one facility triggering the 16-bed threshold.
The guidance goes on to advise: “Because a QRTP is a child-care institution under Title IV-E of the Act and for purposes of Medicaid, the exception for inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 and older in IMDs would not apply. The psych under 21 benefit exception may or may not apply to a particular QRTP…”
The guidance indicates that a state can apply for a waiver through Medicaid 1115 demonstrations. To download the letter, click here.