The bill specifies that the Department of Health Services (DHS) may establish a certification process for and certify psychiatric residential treatment facilities (PRTFs) to provide inpatient psychiatric services for individuals under age 21, under the direction of a physician, with services provided by a facility that meets PRTF standards under federal regulations. The bill also specifies that PRTF services are a reimbursable Medical Assistance (MA) benefit, subject to any necessary federal approval.

The bill specifies certain aspects of PRTF certification. In particular, DHS may make announced and unannounced inspections and complaint investigations of PRTFs as it deems necessary. DHS may limit the number of certifications it grants to operate PRTFs. DHS must, using the DHS’s division of the state into regions by county, include statewide geographic consideration in its evaluation of applications for certification to ensure geographic diversity among the regions in the location of PRTFs.

The bill also grants rule-making authority to DHS to promulgate administrative rules, including emergency rules, to implement the bill. Specifically, DHS may promulgate rules to establish any of the following: (1) minimum security requirements for PRTFs; (2) a target range for the number of beds in a PRTF; (3) policies for coordination between PRTFs and certain other facilities; (4) appropriate staffing level requirements, including policies to ensure the availability of adequate in-person and on-site care; (5) requirements to define the population to be served at a given PRTF, including establishment of any minimum age requirements; and (6) rules and standards for PRTF operations as the department determines are necessary to provide safe and adequate care and treatment of patients and to protect the health and safety of patients and employees of a PRTF.

The bill applies the federal regulatory framework for PRTFs to the state’s regulation of PRTFs, including standards for admission and other conditions for MA participation.

The bill defines a PRTF with the meaning given in the federal regulations. Under those regulations, a PRTF means a facility other than a hospital, that provides psychiatric services to individuals under age 21, in an inpatient setting. The “psychiatric services” are described in federal MA requirements and limits that are applicable to inpatient psychiatric services for individuals under age 21. The bill incorporates those requirements and limits, including requirements to provide active treatment and individual plans of care.

As provided under the federal regulations, the bill specifies that in order to admit an individual for services, a treatment team must certify all of the following: (1) ambulatory care resources available in the community do not meet the treatment needs of the individual; (2) proper treatment of the individual’s psychiatric condition requires services on an inpatient basis under the direction of a physician; and (3) the services can reasonably be expected to improve the individual’s condition or prevent further regression, so that the services will no longer be needed. Under the federal regulations incorporated in the bill, if an individual is an MA participant when admitted to a PRTF, the treatment team must include a physician who has competence in diagnosis and treatment of mental illness, preferably in child psychiatry, and who has knowledge of the individual’s situation.

The bill specifies that a PRTF must comply with all federal conditions of participation, including provisions for the protection of residents, orders for the use of restraint or seclusion, and all other federal conditions of participation that apply to a PRTF.

Additional State Regulations

The bill addresses three aspects of PRTF operation that are not addressed in the federal regulations.

First, the bill specifies that a PRTF may use video surveillance and recordings in common areas, entrances, and exits, without a patient’s consent, but must inform the patient and the patient’s parent, guardian, legal custodian, or Indian custodian of the surveillance and recording. The bill specifies that video surveillance and recording may not be used as a substitute for one-on-one monitoring of a patient who is at high risk for self-harm. It also specifies that any video recording is confidential, except as provided by the department by rule. The department may review any recording made by a PRTF. The bill specifies that DHS may promulgate rules requiring a PRTF to adopt a policy for monitoring safety, which may include the use of video surveillance and recording in common areas, entrances, and exits.

Second, the bill specifies that a PRTF may implement the use of locked units for safety, and specifies that DHS may promulgate rules requiring a PRTF to adopt a policy for the use of locked units for safety.

Third, the bill clarifies that admission to a PRTF is subject to the requirements of Chapter 51, Stats.

Lastly, the bill addresses certain state administrative and operational aspects. This includes: (1) allowing DHS to provide grants to entities to establish a PRTF, with preference toward having at least one PRTF in the northern or north-central region of the state and at least one in the southern region of the state; (2) specifying that a PRTF may seek reimbursement for its services from a private health benefit plan or a self-insured governmental health plan; and (3) providing DHS with position authority for four full-time equivalent positions for the purpose of implementing the certification process and requirements for PRTFs. The bill includes a placeholder to add funding for PRTFs in DHS’s schedule under the biennial state budget.

AB111,2,11920.435 (5) (bt) Psychiatric residential treatment facilities. Biennially, the
10amounts in the schedule for the administration and funding of psychiatric
11residential treatment facilities under s. 51.044.

AB111,3,8

149.46 (2) (bv) The department shall submit to the federal department of
2health and human services any request for a state plan amendment, waiver, or
3other federal approval necessary to provide reimbursement for services by a
4psychiatric residential treatment facility. If the federal department of health and
5human services approves the request or if no federal approval is necessary, the
6department shall provide reimbursement under par. (b) 14c. If the federal
7department of health and human services disapproves the request, the department
8may not provide reimbursement for services under par. (b) 14c.

AB111,3,121051.044 Psychiatric residential treatment facilities. (1) Definition. In
11this section, “psychiatric residential treatment facility” has the meaning given in
1242 CFR 483.352.