Manual: Aged, Blind, and Disabled
Change No. 17-01
To: County Directors of Social Services
Effective: June 1, 2001 Make the following Changes
Effective October 1, 2000, Medicaid began coverage of inpatient treatment in a psychiatric residential treatment facility (PRTF) for individuals under 21. Change No. 08-01 issued eligibility policy for children in PRTFs. This policy was written with the understanding that claims for PRTF would process like claims for inpatient psychiatric hospitals. However, PRTF claims process as nursing facility claims, which require a patient monthly liability (PML). This policy change corrects the initial instructions.
Key points are as follows:
If he has no deductible or his deductible was met prior to entry into the PRTF, his patient monthly liability is $0 effective the date of entry.
If he has a deductible to meet in the month of entry, PRTF daily charges are applied to the deductible. The amount of PRTF charges on the date of authorization is reported in EIS as a patient monthly liability.
An approved FL-2/MR-2 is not required for coverage of PRTF. There is a separate prior approval process for PRTF. Do not delay applying long-term care budgeting awaiting prior approval.
The Manual is updated effective June 1, 2001. Apply this policy to any child admitted to a PRTF whose eligibility determination (application, review, or change in situation) is in process or begins on or after receipt of this material.
Insert attached MA-1100, pages 9 & 10 and 17 & 18.
Insert attached MA-2270, pages 1 & 2, 29 – 30a, and Tables i - iii.
Insert attached MA-2360, pages 1 & 2 and 9 – 14.
If you have any questions, please contact your Medicaid Program Representative.
Paul R. Perruzzi
[This material was written and researched by Andy Wilson, Medicaid Eligibility Policy Unit]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.