On October 19, 2021, CMS put out a new, Qualified Residential Treatment Program (QRTP) Reimbursement: Family First Prevention Services Act (FFPSA) Requirements, Q & A.

The new question and answer appear to be an attempt to address the conflict that some states are facing that by adhering to the new Title IV-E foster care Qualified Residential Treatment Program (QRTP) requirements that went into effect on October 1, 2021, these QRTPs may then be classified by CMS as an IMD—cutting off Medicaid coverage from children and youth in such a QRTP.

CMS states that the set of “Questions and Answers” is to inform states that they can seek to modify the terms of an existing Medicaid section 1115 demonstration opportunity to allow title IV-E beneficiaries to receive coverage in a qualified residential treatment program (QRTP) that is an institution for mental disease (IMD) for longer than that demonstration model currently allows.

In effect if a state has an approved 1115 demonstration waiver for a serious mental illness/serious emotional disturbance (SMI/SED) under current CMS authority, they can seek to modify it and hope to get a quicker response from CMS. Six states (Idaho, Indiana, Oklahoma, Utah, Vermont, and Washington), and the District of Columbia have such a waiver. If a state does not have a waiver, then they must submit a waiver and hope to get CMS approval, a process that could take many months or even years.

The Q & A describes a QRTP: “A QRTP is a CCI that provides a trauma-informed model of care designed to address the needs, including clinical needs, of children with serious emotional or behavioral disorders or disturbances. A QRTP that is a private CCI can accommodate any number of children, though some QRTPs (those that are a public CCI) are limited to 25 children. An IMD is a 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. An IMD facility has more than 16 beds. Therefore, given the interconnectedness of these two definitions, a QRTP facility with more than 16 beds will most likely qualify as an IMD.”

They also say that a child in an IMD is not “disenrolled” from Medicaid however treatment for a child in an IMD cannot be reimbursed for Medicaid covered health care.