Nashville-based Keystone Behavioral Health recently announced the formation of a committee to assess the urgent need for Psychiatric Residential Treatment Facilities. The committee will be led by Mike McCulla and Al Smith, pioneers in the behavioral health industry with extensive experience developing psychiatric hospitals, residential treatment programs and continuums of care for young people and their families. Consisting of mental health professionals, child welfare and juvenile justice experts, managed care/Medicaid leaders, and investors the committee will explore the value that access to PRTFs would bring to communities actively engaged in implementing the initiatives of the Family First Preservation Services Act.
In 2001, the federal government’s Center for Medicaid and Medicare Services (CMS) passed into law the certificate of participation (CoP) for Psychiatric Residential Treatment Facilities (PRTFs) to operate as inpatient psychiatric treatment facilities for individuals 21 years old and under. The CoP establishes PRTFs as an acute psychiatric level of care whose treatment model, like that of a psychiatric hospital, is physician/psychiatrist led. The law established criteria of medical necessity to enter treatment, processes for verifying continuance of treatment, and a pathway for states to federally match funding of PRTF treatment through their state Medicaid plan.
The CMS classification of PRTFs allowed for willing residential treatment programs to adopt PRTF regulatory requirements and evidenced-based treatment practices in order to become credentialed and enrolled in Medicaid and most commercial insurance plans. Unfortunately, adoption of PRTFs by residential programs and state youth serving agencies did not keep pace with the expansion of residential treatment programs throughout the United States. It is estimated that there are 7 residential treatment beds to every 1 PRTF bed in the US today.
Not long after the enactment of PRTFs in 2001, Keystone Behavioral Health’s founders, Mike McCulla and Al Smith, introduced the use of PRTFs through their development of new PRTF programs and conversion of many existing residential treatment programs to PRTFs. “Having developed and managed many psychiatric hospitals and residential treatment programs, we thought the PRTF model established by CMS was the perfect model for ensuring quality care and safety for young people whose treatment needs met the criteria for admission,” says Mike McCulla. “We discovered that the PRTF model was very similar to the services we were providing in psychiatric hospitals, and that because the model allowed for longer lengths of stay than a hospital does, a PRTF was better positioned to transition young people back into their homes. We also discovered that because young people could access treatment at PRTFs through Medicaid and their parents’ insurance, many young people did not have to be committed to state custody just to access out of home treatment, as they had to with residential treatment,” continued McCulla.
The Family First Act became effective on January 1, 2020, but because of the many complexities involved with full implementation of the law, most states have been granted 2-year waivers to complete full compliance. The Family First Act was implemented in part to ensure that all or at least most of federal funding earmarked to keep families together (Title IV-E) was not to be used by child welfare agencies to fund the residential treatment programs in their state. As most states had become reliant on Title IV-E funding to pay for residential treatment, many states are struggling to develop evidenced-based family preservation programs and simultaneously reduce their need/use of residential treatment. “We believe the PRTF model is the perfect solution to replace residential treatment needs for young people who truly require out of home treatment, and that PRTFs have the capacity to become the basis for a continuum of lower level services that will be needed for effective family preservation,” says Al Smith. “We launched Keystone and are organizing the committee to evaluate the validity of our assumptions, as well as how Keystone could use its experience with PRTFs and psychiatric hospitals to offer this very practical solution for keeping kids with their families and community.”
Keystone Behavioral Health specializes in providing psychiatric and behavioral health services to young people 21 and under. Its mission is to reduce the number of young people having to enter state custody in order to access out of home treatment by optimizing the capacities of PRTFs to provide a full continuum of care. For more info, contact Mike McCulla using the form below, or call 615-973-5503.