Certification of Need for Children in a Psychiatric Residential Treatment Facility (PRTF) or an Institution for Mental Diseases (IMD) 510-05-35-30

(Revised 9/1/11 AMENDED ML #3280)

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(N.D.A.C. Section 75-02-02.1-04.1)

Children under age twenty-one who seek services in a Psychiatric Residential Treatment Facility (PRTF), or the state hospital, the Prairie at St. John's center, the Stadter Psychiatric Center, or any other IMD must obtain certification of need in order to be eligible for Medicaid. The certification of need must demonstrate:

Necessity of treatment on an inpatient basis;

That all community resources have been explored prior to admission; and

The treatment to be provided can reasonably be expected to improve the condition.

For a person who attains age twenty-one while receiving treatment and continues to receive treatment as an inpatient, eligibility may continue through the month the individual attains the age of twenty-two.

When a child enters a psychiatric unit in a general hospital or similar facility the child is not in an IMD and the child’s living arrangement is not changed. A certification of need may be created for payment purposes only and will indicate what facility the child is in, so the certification of need must be reviewed to determine if the child’s eligibility is affected.

A child who is residing in an IMD and who is certified as needing that level of care, is only eligible for coverage of the psychiatric services, and is not eligible for services outside of the facility.