MACPAC approved three recommendations on appropriate access to residential treatment services for youth:
- To ensure that states, families, and providers have complete, accurate, and up-to-date information about residential treatment facilities and bed availability, Congress should require that the Secretary of the U.S. Department of Health and Human Services (HHS) develop, maintain, and make publicly available a federally-administered, up-to-date, real-time registry of youth residential treatment facilities serving Medicaid beneficiaries. The Secretary should work with HHS agencies, including the Centers for Medicare & Medicaid Services and the Substance Abuse and Mental Health Services Administration, state Medicaid agencies, state behavioral health agencies, and other stakeholders to develop and maintain this registry. The registry should include information on the behavioral health conditions facilities treat, ages served, real-time updates to bed availability for in- and out-of-state Medicaid beneficiaries, and accessibility of facilities and services for individuals with disabilities. The Secretary should leverage information already being collected by federal agencies and states, while also integrating other information needed to determine whether the facility can meet beneficiary need.
- To ensure that reliable and consistently collected data are publicly available, the Secretary of the U.S. Department of Health and Human Services should direct the Centers for Medicare & Medicaid Services (CMS) to regularly report on the use of residential treatment services by children and youth in Medicaid, including services provided by psychiatric residential treatment facilities (PRTF), non-PRTFs, and out-of-state residential treatment providers. This report should contain data on the characteristics of youth using the services including demographics, disability and co-occurring conditions, and urbanicity and rurality; types of services used; and average length of stay. The report should include data on the use of emergency departments for behavioral health needs, such as emergency department boarding by youth with Medicaid. If data are unavailable to report on key measures, CMS should develop a plan for collecting and publicly reporting on the data elements. CMS should engage states, providers, and other stakeholders in developing the data collection and reporting efforts.
- To ensure that youth discharged from out-of-state residential treatment facilities return to their home states and communities and receive needed services, the Secretary of the U.S. Department of Health and Human Services should direct the Centers for Medicare & Medicaid Services to amend 42 CFR 441.155 to establish minimum requirements for discharge planning processes that mandate that the process involves all relevant actors including providers, plans, and families and caretakers. The requirements should mandate that the process involves identifying an appropriate community provider or alternative residential placement that has the capability and capacity to accept the beneficiary prior to discharge. CMS should also clarify what entities are responsible for initiating and overseeing the discharge planning process for an out-of-state beneficiary, and establish minimum requirements for coordinating and sharing information between the out-of-state provider and the post-discharge providers.
June 2026
No action to date.