Residential Treatment Centers

Residential Treatment Centers, Wraparound and the RTC Medicaid Waiver

Residential Treatment Centers
In Maryland regulation, a “residential treatment center” (RTC) is a psychiatric institution that provides campus-based intensive and extensive evaluation and treatment of children and adolescents with severe and chronic emotional disabilities who require a self-contained therapeutic, educational, and recreational program in a residential setting. Next to inpatient psychiatric hospitalization, an RTC is the second-most restrictive and costly treatment for children and adolescents. Some facts about Maryland RTCs:

• Maryland has 11 RTCs that are licensed by the Department of Health and Mental Hygiene (DHMH). Four facilities serve only boys, and one serves younger children ages 5-13. The other RTCs are co-ed and service adolescents.
• All of the RTCs have their own schools. These schools serve the needs of both the youth in RTCs and those in the neighboring community who need a more intensive school placement.
• About 50% of the youth served by RTCs have been placed there by the Department of Juvenile Services or the Department of Social Services.

It is important to note that RTCs are one small component of the full continuum of care for children. Maryland has been investing in community-based care to keep children with their families and in their communities.

What is the Process for Admission to an RTC?
While it is preferable to keep a child with their family and in their community rather than place a child out of home, in some instances this may be necessary. Accessing an RTC can be a lengthy and complicated process. The process also depends upon whether your child has private insurance or Medical Assistance. An additional consideration is the payment for the educational component of an RTC.

In all cases, your child will only be eligible for admission to an RTC by meeting “Medical Necessity Criteria.” One of the criteria is that your child must have a psychiatric evaluation done within the last 30 days, which states that your child needs RTC level of care. If your child is in the hospital and is being discharged, and a recommendation for an RTC is made, be sure your child’s psychiatrist puts the recommendation for an RTC into writing. The recommendation must state that it is medically necessary for treatment to be 24 hours a day, 7 days a week.

For the definition of the Medical Necessity Criteria for RTC level of care, click here.

If your child has Medicaid
The organization that administers the public mental health system, ValueOptions, will review your child’s psychiatric evaluation and make the determination that your child does or does not meet the criterion for RTC level of care. If your child meets Medical Necessity Criteria for an RTC, the cost of treatment and residential care will be paid by Medicaid.
The next concern is the educational costs for an RTC.

• If your child has an IEP with a non-public school placement, you may directly contact one of the RTCs that are licensed by DHMH for admission to the RTC. The RTC will inform you of the documents you need for approval of admission to the RTC. If you want, you may request the help of your local Core Service Agency (see below) to provide you with additional information and assist you with the application process.
• If your child does not have an IEP with a non-public school placement, but your child does have Medicaid, you need to contact your local Core Service Agency http://www.dhmh.state.md.usmha/csa.html, which will help assist you with gathering appropriate documentation, navigating the approval process, and accessing intensive community-based services prior to admission to an RTC.

If your child has Private Insurance
If your child does not have Medicaid, you must contact your private insurance company to see if your insurance policy covers treatment in an RTC.

If your policy covers an RTC:

• Your insurance company will help you locate an RTC that is in their network. It is important to keep your child as close as possible to home so that you can have frequent visits and stay involved in your child’s treatment.

• If your policy covers treatment in an RTC and your child is denied by the insurance company, you can appeal the decision. All insurance companies must have an appeals process.

If your policy does not cover treatment in an RTC:

• If your child has a non-public school placement, you may directly contact one of the RTCs that are licensed by DHMH for admission to the RTC. The RTC will inform you of the documents you need for approval of admission to the RTC, and the procedures for admission that will ensure that your child’s stay is covered by Medicaid.

• If your child does not have a non-public school placement, you may want to consider a Voluntary Placement Agreement” (VPA). A VPA is an agreement with the Department of Social Services (DSS) to “voluntarily” place your child in the care of DSS for placement in an RTC or other therapeutic setting. In this instance, you will be assessed child support payments based on your income and circumstances. To initiate the process, contact your local Department of Social Services (go to www.dhr.state.md.us and click on “local offices”) and request a Voluntary Placement Agreement. If the local DSS office determines that your child meets the criteria for RTC level of care, they will assist you with navigating the Voluntary Placement Agreement process. This will include a meeting with the Local Care Team (LCT). The LCT will work with the family to determine if intensive community-based services can be provided prior to admission to an RTC.

Other youth may be referred to an RTC through the Department of Juvenile Services or the Department of Social Services.

The following chart lists the RTCs licensed by the Department of Health and Mental Hygiene:

The facilities listed in the chart above represent those programs specifically licensed to serve children with serious mental health needs. Other residential facilities in Maryland may be licensed to serve children involved with other state agencies, such as Juvenile Services or Developmental Disabilities.
Ideally, stays in RTCs should be as short as safely possible. In most cases, youth should begin to re-integrate with their family and community soon after placement. Long-term stays in RTCs have not been found to produce more positive outcomes than shorter stays. Cases are reviewed regularly to determine if the child is able to return to their home and community.