Psychiatric Residential Treatment Facilities (PRTF) Attestations

As required by OAC 317:30-5-95, Psychiatric Residential Treatment Facilities must submit an attestation statement to the Oklahoma Health Care Authority as part of their established provider agreement.

Attestation statements should be uploaded to the facility’s provider file at time of enrollment through the Electronic Provider Enrollment System.

Attestations must include the following information:

  -Facility General Characteristics: name, address, telephone number of the facility, and provider identification number;

    -Facility Specific Characteristics: 

  • Bed size;
  • Number of individuals currently served within the PRTF who are provided service based on their eligibility for the Medicaid Inpatient Psychiatric Services for Individuals Under age 21 Benefit (Psych under 21);
  • Number of individuals, if any, whose Medicaid Inpatient Psychiatric Services Under 21 Benefit is paid for by any State other than Oklahoma; and
  • List all States from which the PRTF has ever received Medicaid payment for the provision of Psych under 21 services.  

   -The signature of the facility director;

   -The date the attestation was signed;

   -A statement certifying that the facility currently meets all of the requirements of Part 483, Subpart G governing the use of restraint and seclusion;

   -A statement acknowledging the right of the SA (or its agents) and, if necessary, CMS to conduct an onsite survey at any time to validate the facility’s compliance with the requirements of the rule, to investigate  complaints lodged against the facility, or to investigate serious occurrences

  -A statement that the facility will submit a new attestation of compliance annually and in the event a new facility director is appointed.