Psychiatric residential treatment facilities services are covered for residents ages 6 to 21 who require treatment on a continuous basis as a result of a severe mental or psychiatric illness.
Psychiatric residential treatment facilities services are designed to serve children who need long-term, more intensive treatment and a more highly structured environment than they can received in family and other community-based alternatives to hospitalization. Less restrictive and more homelike than hospitals, these facilities also serve childrens' transitioning from hospitals, but who still are not ready for the demands of living at home or in a foster home.
Exclusions and Limitations
The following are not be covered as PRTF services:
- Chemical dependency treatment services if the need for the services is the primary diagnosis of the recipient. However, chemical dependency treatment services are covered as incidental treatment if minimal chemical dependency treatment is necessary for successful treatment of the primary diagnosis
- Outpatient services
- Pharmacy services covered as pharmacy services in accordance with
907 KAR 23:010
- Durable medical equipment covered as a durable medical equipment benefit in accordance with
907 KAR 1:479
A PRTF may not charge a recipient or responsible party representing a recipient any difference between private and semiprivate room charges.
Services shall not be covered if appropriate alternative services are available in the community.
The following shall not qualify for a PRTF service:
- An admission that is not medically necessary
- An individual with a major medical problem or minor symptoms
- An individual who might only require a psychiatric consultation rather than an admission to a psychiatric facility
- An individual who might need only adequate living accommodations, economic aid or social support services.
If you are a medicaid benificiary and have questions,contact
Member Services - (800) 635-2570.
Provider Contact information
If you can't find the information you need or have additional questions, please direct your inquiries to: