Virginia MedicaidMedicaid Residential Treatment Services
Residential Treatment Services
The Residential Treatment Services benefit provides services to Medicaid members under 21 that require Psychiatric Residential Treatment Services or Therapeutic Group Home Services.
The Department of Medical Assistance Services shall amend the state plans under Titles XIX and XXI of the Social Security Act, and any waivers thereof, and make any changes to managed care contracts necessary to enable children served in psychiatric residential treatment facilities (PRTF) to maintain their enrollment in managed care during their treatment. The payment for PRTF per diem payments and PRTF required services shall be carved out of managed care and paid as a fee-for-service benefit. Required services include assessment and diagnosis, physician medication management and supervision, urine testing and psychological professional services when delivered by facility staff or contractors. Any service eligible for reimbursement through the Children's Services Act shall not be included in managed care. The department shall have the authority to create a new capitation payment structure to reflect this change in managed care service delivery. Costs associated with any carved-out services shall be excluded from managed care payment methodologies. The department shall have the authority to implement this change effective July 1, 2025 and prior to the completion of any regulatory process.
Access the Related Medicaid PRTF Bulletin: Cardinal Care Managed Care Changes for Youth in Psychiatric Residential Treatment Facilities (PRTFs) Effective November 1, 2025
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