RCPA - Rehabilitation and Community Providers Association


Payment Available for Secure RTFs
September 30, 2002

The Department of Public Welfare Office of Medical Assistance (MA) Programs has released a Bulletin announcing that it will pay for medically necessary services provided in a Secure Care Residential Treatment Facility (RTF). This service is for adjudicated delinquent MA recipients under 21 years of age who have been court ordered into a secure residential placement and who have a diagnosed mental illness or severe emotional disorder, regardless of any additional diagnosis including substance abuse or mental retardation.

In order to participate in and receive payment from the MA Program for RTF services in a secure setting, the facility must be enrolled with OMAP as a MA provider; be licensed under Chapter 3800 as a secure care residential child care facility; and be accredited by JCAHO and be certified by the Office of Mental Health and Substance Abuse Services (OMHSAS) as meeting the Department's Interim Guidelines set forth in OMAP Bulletin #01-93-04 and #1165-95-01, or meet the requirements set forth in OMAP Bulletin #1157-95-01 related to non-JCAHO RTFs and be certified by OMHSAS.

The Department will establish a negotiated per diem rate for each provider to pay for prescribed therapeutic or rehabilitative services. The negotiated per diem rate will be based upon each facility's costs reflected in the facility's cost report and applying Medicare cost reimbursement principles and other reasonableness tests.

The Offices of Medical Assistance Programs (OMAP), Mental Health and Substance Abuse Services (OMHSAS), and Children, Youth and Families have collaborated to develop procedures for enrolling and making payment to in-state providers for this medically necessary secure RTF care. These procedures are described in Medical Assistance Bulletin #17-02-04. This Bulletin is accessible at www.dpw.state.pa.us/omap/provinf/mabull/010211.asp.

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