A psychiatric residential treatment facility (PRTF) is a facility, other than a hospital, that provides inpatient psychiatric services to people under age 21 under the Medicaid rules in 42 CFR Part 441, Subpart D, and that must meet the federal restraint and seclusion condition of participation in 42 CFR Part 483, Subpart G. This page is for organizations that operate, or plan to operate, nonhospital psychiatric residential treatment for young people and need to be ready for Medicaid certification or a state survey. Integral Healthcare Solutions (IHS) writes your PRTF policy set to the federal and state rules; your child and adolescent clinicians approve the clinical content.

Last reviewed: October 2026.

What is a psychiatric residential treatment facility (PRTF)?

The federal definition is in 42 CFR 483.352: "Psychiatric Residential Treatment Facility means a facility other than a hospital, that provides psychiatric services, as described in subpart D of part 441 of this chapter, to individuals under age 21, in an inpatient setting" (42 CFR Part 483, Subpart G).

The federal texts, in the versions reviewed for this page:

• 42 CFR Part 441, Subpart D, "Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs" (§§ 441.150–441.184), eCFR current as of September 30, 2026 (eCFR).
• 42 CFR Part 483, Subpart G, the "Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21" (§§ 483.350–483.376), eCFR current as of September 30, 2026 (eCFR).
• CMS State Operations Manual, Appendix N, "Psychiatric Residential Treatment Facilities (PRTF) Interpretive Guidance," Rev. 131, issued January 16, 2015 (CMS).
• CMS S&C 15-14-PRTF, December 19, 2014, which introduced Appendix N (CMS).

Your state's own PRTF licensing and Medicaid provider rules apply on top of these and differ by state.

A nonhospital PRTF must be accredited. Under 42 CFR 441.151(a)(2)(ii), services must be provided by "A psychiatric facility that is not a hospital and is accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation of Services for Families and Children, or by any other accrediting organization with comparable standards that is recognized by the State" (42 CFR Part 441, Subpart D).

The facility director also signs a federal attestation: "Each psychiatric residential treatment facility that provides inpatient psychiatric services to individuals under age 21 must attest, in writing, that the facility is in compliance with CMS's standards governing the use of restraint and seclusion. This attestation must be signed by the facility director" (42 CFR 483.374(a), eCFR).

Who needs it and what triggers it

PRTF readiness is for organizations operating nonhospital psychiatric residential treatment for people under age 21 that bill, or intend to bill, Medicaid for inpatient psychiatric services. The work usually starts with one of these events:

• Medicaid enrollment. The attestation is due when the provider agreement is signed: "A facility enrolling as a Medicaid provider must meet this requirement at the time it executes a provider agreement with the Medicaid agency" (42 CFR 483.374(a)(2), eCFR).
• Initial certification. CMS's 2014 guidance states: "The initial certification of a PRTF is currently accomplished through an attestation process" (S&C 15-14).
• A state survey. The same guidance states that the state survey agency "conducts surveys (Recertification, Complaint Investigation, and Validation) at least every five (5) years to ensure that the facility remains in compliance with the applicable regulations and the assertions of the attestation" (S&C 15-14).

How IHS helps

IHS works through the same process it uses on every certification program, here against 42 CFR 441 Subpart D, 42 CFR 483 Subpart G and your state's PRTF rules:

1. Gap assessment. IHS compares your current policies to those texts, using questionnaires on the population you serve, staffing and incidents.
2. Document and evidence mapping. IHS builds a crosswalk from each requirement to the policy, record or training evidence that answers it.
3. Drafting. IHS drafts resident rights, serious occurrence reporting, staff training, plan-of-care review and restraint and seclusion procedures. Your child and adolescent clinicians review and approve the clinical content before it is adopted.
4. Mock survey. IHS runs a rehearsal survey against SOM Appendix N.
5. Readiness support. IHS drafts correspondence, such as the facility director's attestation, for your organization to sign and send, and keeps an open-items list until the file is complete.

What your organization supplies: your program model, staffing plan, current policies, and the clinicians who approve the clinical content.

The limit: restraint and seclusion clinical decisions and physical-plant safety stay with your clinicians and facilities staff. The choice of accreditor and the accreditation survey itself are yours. IHS drafts; your facility director signs and your organization submits.

Related IHS pages: Compliance Services, Accreditation Consulting and Program Development.

What to have ready

Each item below ties to the federal text reviewed for this page (eCFR current as of September 30, 2026, unless noted).

• A program description showing psychiatric services to individuals under age 21 in an inpatient setting, in a facility other than a hospital (42 CFR 483.352, eCFR).
• Current accreditation, or your decision among the Joint Commission, CARF, COA or another accrediting organization with comparable standards recognized by your state (42 CFR 441.151(a)(2)(ii), eCFR).
• A restraint and seclusion attestation ready for the facility director's signature (42 CFR 483.374(a), eCFR).
• Restraint and seclusion order procedures that state the federal limits: "4 hours for residents ages 18 to 21; 2 hours for residents ages 9 to 17; or 1 hour for residents under age 9" (42 CFR 483.358(e)(2), eCFR).
• A plan-of-care process with plans "Developed and implemented no later than 14 days after admission" (42 CFR 441.154(a)) and "reviewed every 30 days by the team specified in § 441.156" (42 CFR 441.155(c), eCFR).
• A serious occurrence procedure that reports to both the State Medicaid agency and the State-designated Protection and Advocacy system "by no later than close of business the next business day after a serious occurrence" (42 CFR 483.374(b)(1), eCFR).
• An emergency preparedness plan "reviewed, and updated at least every 2 years" (42 CFR 441.184(a), eCFR).
• Reports and plans of correction from any prior state survey, since recertification surveys recur within a five-year cycle (S&C 15-14, December 2014, CMS).

When these are together, the introductory call is the place to start.

How it compares

The federal rule allows inpatient psychiatric services for people under 21 in more than one setting, and a nonhospital PRTF has more than one accreditation route.

What it costs

CMS does not publish a fee schedule for PRTF certification on the pages we reviewed; fees depend on scope. Accreditor fees are not covered on this page. IHS scopes each engagement after a free introductory call.

What this is not

• This page is not legal advice, and IHS does not decide whether your program qualifies as a PRTF under your state's rules.
• IHS does not sign or submit the attestation, enroll you with the Medicaid agency, or correspond with the state survey agency or your accreditor. Your organization signs and submits; IHS drafts.
• IHS does not make restraint, seclusion or treatment decisions and does not guarantee a survey or accreditation outcome.

Frequently asked questions

What is a psychiatric residential treatment facility (PRTF) under Medicaid?

42 CFR 483.352 defines a PRTF as a facility other than a hospital that provides psychiatric services, as described in 42 CFR Part 441 Subpart D, to individuals under age 21 in an inpatient setting. It must also meet the restraint and seclusion condition of participation in 42 CFR Part 483 Subpart G.

Does our youth residential program need to be a PRTF to bill Medicaid for inpatient psychiatric services under 21?

Under 42 CFR 441.151(a)(2), these services are provided either by a psychiatric hospital that undergoes a State survey or holds CMS-approved accreditation, or by a nonhospital psychiatric facility accredited as the rule describes. Whether your specific program qualifies also depends on your state's rules, which this page does not cover.

Which accreditation does a PRTF need: Joint Commission, CARF or COA?

42 CFR 441.151(a)(2)(ii) names the Joint Commission, the Commission on Accreditation of Rehabilitation Facilities and the Council on Accreditation of Services for Families and Children, or any other accrediting organization with comparable standards that is recognized by the State. The regulation does not rank them. The choice of accreditor is yours.

How does a PRTF get Medicaid certified, and what is the restraint and seclusion attestation?

CMS's 2014 guidance, S&C 15-14, states that initial certification of a PRTF is accomplished through an attestation process. Under 42 CFR 483.374(a), the facility must attest in writing that it complies with CMS's restraint and seclusion standards, signed by the facility director, at the time it executes a provider agreement with the Medicaid agency. IHS can draft the attestation; your facility director signs it.

How often are PRTFs surveyed by the state survey agency?

S&C 15-14 states that the state survey agency conducts recertification, complaint investigation and validation surveys at least every five years. It also states that survey agencies must survey 20 percent of all PRTFs in the state each year and all PRTFs within a five-year period. That guidance is dated December 2014.

What are the federal time limits on restraint and seclusion orders in a PRTF?

42 CFR 483.358(e)(2) states that each order must under no circumstances exceed 4 hours for residents ages 18 to 21, 2 hours for residents ages 9 to 17, or 1 hour for residents under age 9. Your clinicians make the clinical decisions within these limits.

Who must a PRTF report a serious occurrence to, and by when?

Under 42 CFR 483.374(b)(1), staff must report any serious occurrence involving a resident to both the State Medicaid agency and the State-designated Protection and Advocacy system. The deadline is no later than close of business the next business day after the serious occurrence.

What has to be in a PRTF individual plan of care, and how often is it reviewed?

42 CFR 441.154(a) requires a plan of care developed and implemented no later than 14 days after admission. 42 CFR 441.155(c) requires the plan to be reviewed every 30 days by the team specified in 42 CFR 441.156. IHS drafts the review procedure; your clinicians write and own each plan.

How long does PRTF readiness usually take from accreditation to Medicaid enrollment?

CMS does not publish a readiness timeline on the pages we reviewed. Timing depends on your accreditation status, your state's enrollment process and how many of the required policies already exist. IHS sets a working plan with you after the introductory call.

What does a consultant do in PRTF readiness, and what stays with our clinicians?

IHS runs a gap assessment, maps requirements to evidence, drafts the policy set, runs a mock survey against SOM Appendix N and drafts correspondence for you to sign and send. Restraint and seclusion clinical decisions, treatment content approval and physical-plant safety stay with your clinicians and facilities staff.