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Psychiatric Residential Treatment Facilities (PRTFs) deliver services under the direction of a physician, seven days per week, to residents and their families. Services include individual, family, and group therapy. Children and youth under age 21 are eligible for admission based on medical necessity.
Recent process changes directed the state to implement the following changes to PRTF medical necessity reviews:
- The Behavioral Health Division (BHD) is requesting that referrals for PRTF medical necessity reviews for all youth who qualify for Medical Assistance (MA) Fee for Services (FFS) come directly to the BHD from the community licensed mental health professional (MN Statute 245.462, Subd. 18) via an encrypted email to prtf@state.mn.us; and
- The BHD will continue to coordinate a statewide list of children who meet PRTF medical necessity criteria and are awaiting admission.
In order for the State to determine medical necessity for MA FFS members, a recent diagnostic assessment (DA) is requested. In lieu of a DA, the following documentation is acceptable, as long as components of a standard DA are included:
- Psychiatric Evaluation
- Psychological Evaluation
- Neuropsychological Evaluation
Other documentation required include the DHS-7696 form and supporting clinical documentation. The DHS-7696 form must be completed and signed by a community licensed mental health professional. Incomplete documentation will be returned and result in delays in review.
Please direct all referral inquiries or questions to dhs.prtf@state.mn.us.
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