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Community-Based Alternatives for Children in Psychiatric Residential Treatment Facilities (PRTFs) Demonstration Grant Program The New Freedom Commission on Mental Health (the Commission), created on April 29, 2002, as part of the New Freedom Initiative (NFI,) was charged with making recommendations to the President that would enable adults with serious mental illnesses and youth with serious emotional disturbances to live, work, learn, and participate fully in the their communities. On July 26, 2003, the Commission released its final report, "Achieving the Promise: Transforming Mental Health Care in America", which outlined significant problems associated with providing community-based alternatives to youth with serious emotional disturbances. Youth and families typically have little influence over decisions affecting service delivery, planning and the use of financing to deliver care. When comprehensive community-based options are not available, youth are often placed in out-of-state facilities, child welfare or juvenile justice systems so that they could receive mental health services. The Commission recommended that a demonstration be conducted in order to allow the Centers for Medicare & Medicaid Services (CMS) to develop reliable cost and utilization data. This data would then be used to evaluate the impact of Medicaid waiver services on the effectiveness of community placements for youth with serious emotional disturbances in PRTFs. Community Alternatives to PRTFs Over the last decade, PRTFs have become the primary provider for youth with serious emotional disturbances requiring an institutional level of care. However, since they are not recognized as hospitals, nursing facilities or intermediate care facilities for the mentally retarded, many States have been unable to use the 1915(c) waiver authority to provide home and community-based alternatives to care which would keep the youth in their homes and with their families. Section 6063 of the DRA of 2005 addresses this issue by providing up to $217 million to up to 10 States to develop demonstration programs that provide home and community-based services to youth as alternatives to PRTFs. CMS will award each successful applicant demonstration grant funding over the authorized five year grant period through fiscal year 2012. Section 6063 also provides for a National Demonstration Evaluation. The contract was awarded to IMPAQ International, LCC. The contractor will conduct the evaluation to answer two questions. One, do the children and youth who receive PRTF home and community-based waiver services, under this demonstration, maintain or improve their functional level? Two, is the provision of home and community-based waiver services cost effective compared to the provision of services in a psychiatric residential treatment facility? Current Status In 2007 CMS awarded: Alaska, Florida, Georgia, Indiana, Kansas, Maryland, Mississippi, Montana, South Carolina and Virginia. These States completed 1915(c) Home and Community-based waiver applications. Alaska, Georgia, Indiana, Kansas, Maryland, Mississippi, Montana, South Carolina and Virginia have approved waivers. As of 10/01/08, 253 children are enrolled as participants and are receiving waiver services. Florida's grant is being held in abeyance pending the Florida legislature appropriating matching State funds required by Section 6063. It is anticipated that over 1,000 children will be receiving demonstration waiver services under these grants by October of 2009.
Page Last Modified: 12/15/2008 2:16:03 PM
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