QRTP Placements 624-05-20-17

(Revised 10/1/2024 ML #3864)

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Qualified Residential Treatment Programs (QRTP) are short-term residential treatment options providing trauma-informed treatment designed to address the serious complex behavioral health needs of children in need of residential treatment. Custodial agencies seeking placement in a ND QRTP must make a referral through the Children’s Treatment Services Level of Care Determination assessment process. For more information on symptoms and behaviors of eligible children, see the Level of Care chart for reference.


Placement Approvals into QRTP

A child who has been approved and placed at the QRTP will be granted an approval for a 90-period beginning at the date of placement. The custodial case worker does not need pre-approval before placement can occur.

  1. Initial 30-day window: The approval to be placed in a QRTP is valid up to 30 days; meaning a child must be placed in the QRTP within 30 days of receiving the approval from the Qualified Individual, unless otherwise approved by the department. If the QRTP placement is not available for more than 30 days or pre-approved by the department, a new SFN 824 and Children's Treatment Services Level of Care Determination assessment must be completed.

  2. Bed Hold: If a child who has been approved and placed at a QRTP needs of temporary psychiatric hospitalization, the temporary hospitalization is allowable. The QRTP is allowed reimbursement for a 14-day bed hold so long as the QRTP is accepting the child back into treatment. A new assessment is not required, so long as the approval has not expired.

  3. Transition: A child may be transitioned from one QRTP to another if it is determined in the best interest for their treatment. The child will require a new QRTP assessment to approve or deny the placement into a new QRTP location. The placement maximums and approval timeframes remain.

  4. Post-Discharge: A child who discharges from a QRTP, but still has a period of time allowed within their 90-day approval time frame may be re-admitted if determined necessary for treatment but, a new SFN 824 and Children's Treatment Services Level of Care Determination assessment must be completed.

  5. Denial: A child who is placed in a QRTP and who is denied must discharge within the approval time frames. The custodial agency and QRTP who allow a child to remain placed without valid QRTP approval is in non-compliance with state licensing and federal regulation.

  6. “Back-to-Back” placements are prohibited. If the child was approved and is later denied, the child may not remain in or re-enter the QRTP for 30 days post discharge.

  7. Turning 18: A child who has current QRTP approval that extends beyond their 18th birthday, must discharge QRTP placement on their 18th birthday.


Placement Maximums

QRTP placement is closely regulated by federal regulations and the age of the child. A child in foster care age 13 years and older shall not exceed placement into a QRTP for more than 12 consecutive months (365 days) or 18 non-consecutive months (545 days). A child in foster care age 12 and younger shall not exceed placement in a QRTP for more than 6 consecutive months (180 days).

 

A child who has been placed at a QRTP for 12 consecutive months has reached their placement maximum and may not re-enter a QRTP facility for a period of 90 days unless high-risk behaviors are present. High-risk behaviors include danger to self or others, self-injurious behaviors, sexual aggression, fire setting and runaway if present with additional dangerous behaviors, or the child runs to unsafe environments where the likelihood to be victimized is high. If placement is determined necessary in less than 90 days, the custodian must request permission from the Children and Family Services (CFS) via cfslicensing@nd.gov. This will provide authorization to place a child back into a QRTP. If reviewed and approved by the CFS Licensing Unit the custodial case worker will be notified and responsible to submit the universal application and supporting documentation to Assessment Pro.

Turning age 13 Example: If a 12-year-old is placed at the QRTP and turns 13 during their placement stay, those days already placed at a QRTP are part of their placement maximums of 12 consecutive months because the child is now 13. The placement maximums in this example begin the date the child entered the QRTP when he/she was 12. The child is 12 and six months of placement is expiring, however the child will soon turn age 13 and has a valid QRTP approval that extends beyond the child’s 13th birthday, a placement extension request must still be made to the Department. This is a notification of the current placement, birthday of the child, approval to continue treatment and a request to extend until the 13th birthday to fill the gap.

 

The placement maximums are specific to the QRTP level of care (both in and out of state), not individual facilities. It is important that case workers are aware of and track the placement maximums, while recognizing the importance of referring children to a QRTP only if he/she needs treatment. If the length of stay is greater than the federal requirements, state approval from the ND Department of Health and Human Services Commissioner is required. This process for a placement extension will be requested by the custodial case worker at least 30 days prior to reaching placement maximums.

 

In order to request a placement extension beyond the allocated federal maximum, the custodial case worker must follow policy 623-05-20-13.

 

QRTP Aftercare Services

When a child is approved and admitted for QRTP treatment, the child is required to be provided aftercare services by the QRTP facility per NDAC 75-03-40 post discharge.

 

If a child is placed as an emergency placement and denied for QRTP level of care, the child does not meet the eligibility of a treatment resident and the facility is not required to provide the aftercare services.

 

Aftercare services shall include coordinating of services, supporting the current placement location (relative, foster home, parent, etc.), tracking of client outcomes and other tasks as defined by the QRTP. The outcomes will be collected by the QRTP in conjunction with the youth and the family at six-months post-discharge.

 

Out of State Placements

North Dakota foster children in need of out-of-state placement may only be placed in a Qualified Residential Treatment Program (QRTP) facility that meets the federal standards. Foster care funding will only support the reimbursement of placement in a QRTP residential level of care. Placement maximums also apply to children placed in an out of state QRTP.

 

The Department does not prohibit children from being placed outside of the state of North Dakota, however it is highly discouraged to place a child away from their connections and reunification or permanency plan options. If seeking an out of state placement, Interstate Compact for the Placement of Children (ICPC) must be followed. Before seeking out of state QRTP placement, all in-state QRTP facilities must deny the child for admission. The current list of approved out of state facilities is located online at the Children and Family Services website.

For children under the custody of another state, seeking placement in a ND QRTP: The sending state must complete the ICPC and payment paperwork before placement can occur in efforts to ensure the QRTP assessment is paid for by the sending state and the ND QRTP is reimbursed the ND daily rate for service.

 

QRTP Reimbursement

The Department will authorize all eligible QRTP payments directly to the QRTP facility based on billing. A child is prohibited from being placed or remaining in placement at a QRTP without an approval, with the exception of emergency placements not to exceed 30 days.

 

If the child is placed at a QRTP and their approval expires, the child must be discharged from the placement location effective the date of expiration. It is imperative that custodial case managers monitor the approval timeframes.