State implements single assessment for youth levels of care and seeks funds for voluntary treatment, partial hospitalization and youth crisis services

Dr. Shawna Eberhardt, clinical director for behavioral health policy, and Dr. Melissa Kynes, utilization-review administrator with Medical Services, briefed the Appropriations Committee on changes to how the state assesses and routes children and youth to higher levels of behavioral-health care.

One‑assessment rollout: Dr. Kynes said federal rules require independent review when Medicaid-eligible youth are admitted to inpatient psychiatric services and that North Dakota implemented a single, consolidated review process—called the "1 assessment"—effective July 1, 2024. The state contracts with an independent vendor (Maximus) to conduct clinical reviews, interview families and issue level-of-care determinations for psychiatric residential treatment facilities (PRTFs), qualified residential treatment programs (QRTPs) and treatment foster care (TFC).

Kynes told the committee there were 413 assessments in the first six months of full implementation, with 355 approvals for PRTF, QRTP or TFC levels of care; she also described how the consolidated process replaces multiple, fragmented entry points and creates a single point of entry so families receive consistent clinical review and state staff can better identify trends.

Voluntary Treatment Program (VTP): Dr. Eberhardt described the VTP, which helps Medicaid-eligible children from private family homes access QRTP placements where clinically appropriate. She said the program’s average episode cost in recent data was about $70,000 per child and that the division had used mental-health block-grant funds to continue placements when statutory appropriations were exhausted; the division requested additional funds so a larger number of youth could be served in the coming biennium.

Partial hospitalization/intensive day treatment and youth crisis services: Eberhardt said access to partial-hospitalization programs (PHPs) and intensive-day treatment is limited in the state and requested funding to develop or expand those services. She also described a proposed youth crisis residential option—non-ER receiving and stabilization centers tailored for children—that would provide short-term, trauma-informed placements and multidisciplinary staffing as an alternative to emergency rooms, detention or certified shelters.

Trauma-focused therapy: The division asked for continued and expanded funding for trauma-focused cognitive behavioral therapy (TF-CBT) training and technical assistance (Treatment Collaborative for Traumatized Youth). The agency reported about 550 clinicians trained since project start and asked for funding to add workshops, expand western‑North Dakota training and increase ongoing technical assistance.

Committee members asked for additional operational data, including the number of youth currently in out-of-home placements, bed availability in PRTFs (agency listed a total licensed capacity of 82 beds and about 73 operational beds) and how many additional inpatient or residential beds might be needed. Agency staff said some of those needs may be addressed by building partial-hospitalization capacity and by expanding community-based services to avoid higher levels of care when clinically appropriate.

Ending: The 1 assessment creates a single, documented pathway for clinical review; the division asked for decision-package funding for VTP, partial-hospitalization start-up, youth crisis residence pilots and TF-CBT expansion and said it would provide further data on capacity and need.