Update Qualified Residential Treatment Programs – Institutions for Mental Diseases

In 2021, PCCYFS joined over 600 organizations on a joint letter urging Congress to exempt Qualified Residential Treatment Programs (QRTPs) from the Institutions for Mental Diseases (IMD) exclusion. While Pennsylvania does not have QRTP’s, PCCYFS believes it is important to support providers who do have contracts in other states requiring QRTP’s. The following has been shared by Together, the Voice.

As a result, members of Congress introduced The Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 (117^th Congress H.R.5414, S. 2689), bipartisan, bicameral legislation to ensure that children in foster care with assessed behavioral and mental health needs would not be at risk of losing their federal Medicaid coverage if placed in a QRTP over 16 beds.

Unfortunately, the bill was not passed into law. We have seen states reduce QRTP capacity to avoid the IMD exclusion, lose federal Medicaid funding for foster children residing in QRTPs that have been deemed IMDs, and states are generally struggling to meet the needs of children. Across the nation children are sleeping in unregulated settings, like offices, hotels, and repurposed jails, boarding in emergency departments, languishing in locked psychiatric facilities beyond medical necessity, or otherwise unable to access needed care and services.

Ensuring Medicaid Continuity for Children in Foster Care Act of 2023 (H.R. 4056) was introduced last week and is one of several bills being discussed as part of the SUPPORT Act reauthorization package today! In the hearing memo, the bill is described as fulfilling the following purpose:

H.R. 4056, the Ensuring Medicaid Continuity for Children in Foster Care Act of 2023 (Reps. Gus Bilirakis and Kathy Castor; Rep. Judy Chu original co-sponsor)

H.R. 4056 would lift the IMD Exclusion for “qualified residential treatment programs” (QRTPs), which provide short-term, residential care for foster youth in crisis. The bill would lift the Exclusion in a manner consistent with guardrails from the Family First Prevention Services Act, which include screenings to place children appropriately in and out of care and requirements to discharge children from facilities expeditiously so that they can return to their families as quickly as possible.

The hearing livestream and recording can be found here. About an hour and 40 minutes into the hearing, you will hear Rep. Bilirakis give an impassioned speech about why bipartisan legislation exempting QRTPs from the IMD exclusion is critical.

Sign on again!

The deadline has passed for implementation of all provisions of the landmark Family First Prevention Services Act. However, we continue to see incomplete, delayed, and in some states no implementation of Qualified Residential Treatment Programs (QRTPs) and the protections they provide to youth in foster care. Please join us again in a sign-on letter to lawmakers urging Congress to exempt Qualified Residential Treatment Programs (QRTPs) from the Institutions for Mental Diseases (IMD) exclusion.

Local, state, and national organizations can sign on to help make sure Congress understands the issue and the need to support access to trauma-responsive, youth-driven, family-focused QRTPs nationwide. (see IMD Federal Policy Brief from the National Association of Medicaid Directors).

FFPSA is a signature achievement for children and their families. We strongly agree with prioritizing prevention and stabilizing families so that foster care is not necessary. At the same time, FFPSA also explicitly recognizes a limited but important role for high-quality residential treatment. Resolving the conflict between the IMD exclusion and QRTPs will allow states to move forward confidently with QRTP implementation, ensuring each child’s physical, emotional, and mental well-being is fully supported. You can review the full text of the letter here.

SIGN ON to the letter HERE, ASAP by COB Friday, June 30^th.

If you have any questions or need additional information, contact Lisette Burton, J.D. at lburton@togetherthevoice.org or 919-728-4182.