Manual: Family and Children Medicaid
Change No. 14-01
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. 05-01 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). Therefore, the instructions treating admission to a PRTF as private living for which a deductible balance was entered in EIS were incorrect. This policy change corrects those instructions.
The key points are as follows:
• Whenever a child under 21 is admitted to a PRTF and is eligible for Medicaid, a PML (which may be $0) must be entered in EIS.
• A child who is not expected to be in a PRTF for more than 12 consecutive months is budgeted as in a private living arrangement according to MA-3270. If he has no deductible, or has met his deductible when he enters the PRTF, his PML is $0. If he meets a deductible after entering the PRTF, the amount of PRTF charges applied to his deductible on the date the deductible is met is his PML.
• A child who is expected to be in a PRTF for more than 12 consecutive months is budgeted as in long-term care and a patient monthly liability determined, according to MA-3290.
NOTE: It is highly unlikely that a child will be placed in a PRTF for more than 12 consecutive months. Therefore, in Family and Children Medicaid, virtually all children will be budgeted private living.
• Parental financial responsibility does not apply for child who has been out of his home for more than 12 months or is anticipated to be out of their home for more than 12 months. This could be in a PRTF or in a variety of placements, including a PRTF.
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-3270, pages 3 & 4 and 21 – 26.
Insert attached MA-3325, pages 1 & 2, 5 - 14, and 23 & 24.
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.