The Family First Prevention Services Act, which intended to promote the deinstitutionalization of services for foster care youth, created a new type of behavioral health service setting called Qualified Residential Treatment Programs (QRTPs). In response, many states and providers began transitioning their foster youth services to meet the definition of a QRTP. However, the Centers for Medicare & Medicaid Services (CMS) then issued guidance strongly suggesting that QRTPs cannot have more than 16 beds due to Medicaid’s “institutions for mental diseases” (IMD) exclusion, creating access-to-care and budgetary issues for states.
NAMD sent a letter to Administrator Brooks-LaSure requesting that CMS revisit this interpretation and grant states additional flexibilities as they work to deinstitutionalize their foster care systems. Specifically, NAMD asked that CMS give states a minimum of five years to conduct IMD assessments of their QRTPs, provide greater deference to these state determinations, and allow states to exclude QRTPs from the IMD definition.