About the Bill
HB1653 | Rep. Frances Cavenaugh and Sen. Missy Irvin | House Committee on Public Health, Welfare, and Labor
This bill would allow the number of psychiatric residential treatment facility (PRTF) beds in Arkansas to increase to a total of 900 beds. It would also classify PRTFs as a “long-term care facility” and move the oversight of PRTFs from the Child Welfare Agency Review Board to the DHS Office of Long Term Care.
AACF Testimony on April 7, Senate Committee On Public Health, Welfare, and Labor
Christin Harper, Policy Director, Arkansas Advocates for Children and Families
Good morning, Madame Chair and members of the committee. My name is Christin Harper. I’m with Arkansas Advocates for Children and Families. For almost 50 years, Arkansas Advocates has worked to support public policy that serves all children and families, and I urge you to vote no HB1653 as it is currently written.
Allowing psychiatric residential treatment facilities (PRTFs) to expand in Arkansas – especially without first addressing quality standards within them – will only result in more children being institutionalized in this incredibly restrictive placement type in the short-term and negatively impact their long-term behavioral, social, emotional, and educational well-being.
For context, I worked for the Division of Children and Family Services (DCFS) for almost fifteen years. I am not aware of any research or data indicating that PRTFs produce positive outcomes. I witnessed first-hand the challenges many of these youth experienced in terms of the lack of quality education, social skills, and basic life skills needed to function outside of a facility. In some cases, there are issues with overly medicating children to the point they cannot properly respond to other therapeutic modalities or the education provided. These facilities have ongoing safety issues with regular reports made to the Child Abuse Hotline. Please know that children as young as six-years-old can be and have been placed in PRTFs.
Also keep in mind that on any given day about half of the PRTF beds in Arkansas are filled by children from other states. The demand for beds could be addressed by limiting that practice instead of adding more PRTF beds to the state. Without limiting the placement of children from other states, there is no guarantee that these additional beds will serve Arkansas children.
In some respects, this bill would clean up previous licensing and nomenclature issues, specifically for the beds referenced on p. 2, lines 5-8 of the bill. Those are existing beds already serving children in the capacity of a PRTF, so we do not take issue with classifying those as PRTFs. However, for the beds discussed on p. 2, lines 9-11. These are a little over 100 beds, most of which were built by providers when they had neither a permit from the Health Services Permit Agency nor a license from the Child Welfare Agency Review Board. They are not currently serving children, and it does not make sense to reward providers who built beds without the appropriate authority to do so.
Our other major concern is that this bill strikes the quality of care standards for PRTFs that were enacted in the 2023 session. You will see that deletion begins on p. 15 of the bill and then continues on throughout much of p. 16. On p. 9, HB1653 does require DHS to promulgate rules that are supposed to include quality of care, but it is unclear why the quality of care framework currently in law was removed. After Act 806 was passed, those quality of care standards were placed in the Minimum Licensing Standards for Residential Placements in June 2024 but were not expanded upon. A much better place for those quality of care standards would be the Medicaid manual that is referenced in here but even then, only if more directives are given to providers in terms of what this framework looks like on a day-to-day, operational basis. Further, it will be critical to ensure consistent monitoring to reduce the gaps between policy and practice.
Before we expand the number of PRTFs, it would make sense to allow the transition to the Office of Long-Term Care to take place and for these rules and corresponding manuals to be implemented. With the Office of Long -Term Care taking over monitoring of these facilities, they have to include clear metrics that can allow that office or Medicaid to assess and monitor outcomes of children placed in these facilities in a consistent way. If we see improvements based on the move to the Office of Long-Term Care and the established manuals, then it would make sense to add more PRTF beds at that time, specifically those referenced on p. 2, lines 9-11.
The emergency clause references a demand for beds. A demand for this placement type does not make it the right option for all children experiencing behavioral and mental health challenges – especially if the stay in the PRTF is not coupled with intensive outpatient services upon discharge. Part of the need for PRTFs stems from a lack of evidenced-based, trauma informed mental health and substance use disorder services– in terms of both limited access generally, as well as a lack specifically of intensive outpatient options.
I did not see a fiscal impact associated with this bill. However, for the children covered by Arkansas Medicaid who might be placed in one of these new beds, that will be a fiscal impact to the tune of about $15 million/year. If we are going to spend that kind of money, it would seem that a much better investment would be in community-based mental health and substance use disorder services.
PRTFs are one of the most restrictive care settings and should be utilized sparingly as a behavioral health care option. They are not – and not should not be used – as long-term treatment or placement options for children, especially with little proof to show that children’s behavior is improved by PRTFs and studies showing the harm that occurs to children who have extended stays, so I ask you to please vote no on HB1653 as it is currently written. Thank you.