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What It Is

​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.

Services

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 children transitioning from hospitals, but who still are not ready for the demands of living at home or in a foster home.

For more information, visit the Department for Behavioral Health, Development and Intellectual Disabilities (DBHDID) website.

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 1:019
  • 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.

Information

Regarding billing: contact HP at 800-807-1232 or visit the website.

Regarding members: contact 800-635-2570.

Regarding Provider Enrollment: contact Provider Enrollment at 877-838-5085 or visit the website.

Documentation