Psychiatric Residential Treatment Facilities (PRTF)

Community Behavioral Health (CBH) is soliciting applications for Psychiatric Residential Treatment Facilities (PRTF) to increase local capacity for the population of youth with complex needs. CBH recognizes the need for youth to have access to safe, in-community facilities to meet treatment needs, while integrating family members and member voice throughout care for youth ages 6-18. The PRTFs must demonstrate high competency in treating intense emotional and behavioral challenges, including aggression; histories of trauma, multiple placements, elopement; co-occurring developmental disabilities; and co-occurring addiction needs. Interested qualified applicants should complete the below application. CBH will review all submissions and will contact qualified applicants.

Person Completing Form*

Name and title of person completing form

Provider Name*

Please include the name of the organization/facility interested in joining the CBH provider network

Contact Email*

Please enter the email of the point person responsible for credentialing. Follow-up regarding next steps will be emailed to this address.

Are you enrolled in Pennsylvania Medicaid?*

Are you currently enrolled in PROMISe with the appropriate Provider Type and Specialty?

Select

Were you previously an in-network CBH provider?*

Select or enter value

Why did you previously leave the CBH network?*

Guidelines & Performance Standards*

Do you agree to adhere to CBH’s Clinical Practice Guidelines and Performance Standards included in the CBH Provider Manual?

Select

License*

Please attach a copy of your PRTF license

Drag and drop files here or

Note/Comments

Send me a copy of my responses

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