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Commonwealth's Counties

Workgroup on Children’s Residential Placements Begins Discussions

Legislation enacted in 2020 directed the convening of a workgroup to review the current process for approving residential psychiatric placements for children and barriers to timely approval of placements, and to make recommendations for ways to expedite the approval process. The workgroup held its first meeting on September 1, beginning with an overview of the current process and some initial discussion about potential improvements.

The current process for Medicaid-funded placements in residential treatment is complex and was overhauled in 2017 to make the state’s contracted behavioral health administrator, Magellan, the single point of entry for admissions. In general, the process starts when an inquiry is made to Magellan, typically by the child’s parent or guardian, private provider, a local Children’s Services Act Family Assessment and Planning Team (FAPT), or residential or inpatient facility. Magellan staff then contact the parent or guardian and provide information on the admission process as well as available community-based services. If the parent/guardian decides to move forward with the residential admission process, the case is referred to an Independent Assessment, Certification, and Coordination Team (IACCT), which makes an assessment, coordinates with the child’s physician or psychiatrist, and makes a recommendation within certain specified timelines. Magellan staff review the recommendation to determine if medical necessity criteria are met. There are certain exceptions to this process, such as emergency placements of children in foster care, or cases in which children are already in residential treatment (through private insurance or another payment source) and become eligible for Medicaid afterwards.

Localities are involved in this process in several ways. Local governments contribute a portion of the state’s share of the Medicaid funding for residential treatment, and educational services provided to children in residential treatment facilities are funded through the Children’s Services Act, as are all costs for placements that are not covered by Medicaid. Coordination between the IACCT and the local CSA office is intended to ensure that children not previously involved with the local CSA office receive a CSA eligibility determination and service planning, as appropriate.

Specific issues raised during the workgroup’s discussion include challenges in finding placements for children in inpatient care; the complexity of managing care in localities in which the IACCT may not be well connected to the local staff working with the child and family; whether Medicaid rates should be adjusted to encourage more participation by providers, especially for hard-to-serve populations, such as highly aggressive youth; and the need to increase community-based care options, especially in smaller localities with fewer resources.

The workgroup is scheduled to meet twice more, with subgroups meeting in the intervening weeks. A report is due on December 1.

VACo Contact: Katie Boyle

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