Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) Coverage Criteria
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Defines coverage intent and basic program parameters for AIS and CFIT home- and community-based behavioral health services for commercially insured members of Blue Cross & Blue Shield of Rhode Island.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage with criteria
Covered when ALL of the following apply
Commercial products only; CFIT age limit applies
Services generally for members not at imminent risk of serious harm; may have difficulty performing activities of daily living
Applies to both AIS and CFIT
This policy applies to members enrolled in Commercial products only. Benefits, coverage, and program access for AIS and CFIT may vary by group or contract; providers must verify the member's applicable behavioral health benefits using the Benefit Booklet or Subscriber Agreement before initiating services.
Reimbursement and Coding
| No codes listed |
| all-inclusive per diem | The provider will be reimbursed at an all-inclusive per diem payment schedule. |
Provider Actions and Requirements
Utilization management contact
Contact BCBSRI Behavioral Health Utilization Management for program access, eligibility confirmation, and additional information.
- BCBSRI Behavioral Health Utilization Management: 1-800-274-2958
Member eligibility
CFIT is intended for covered dependent children and is available only until the member’s 19th birthday. CFIT services must meet the program’s minimum service intensity of six (6) contact hours per week.
- CFIT eligibility: covered dependent child, age < 19
- Minimum CFIT service intensity: 6 contact hours/week
Position in treatment continuum
AIS/CFIT are provided as less-restrictive, intensive community-based options and may be used either as a step-up from traditional outpatient services or as a step-down from more intensive settings (e.g., inpatient hospitalization or residential treatment).
- Position in continuum: step-up from outpatient services
- Position in continuum: step-down from inpatient or residential care
Benefit verification required
Verify the member’s applicable behavioral health benefits prior to service delivery. Coverage may vary by group or contract; consult the member’s Benefit Booklet or Subscriber Agreement.
- Confirm behavioral health benefits and any applicable limitations in the member’s Benefit Booklet or Subscriber Agreement
Background
Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) are home- and community-based behavioral health programs designed to provide intensive treatment to adults and children experiencing moderate to severe psychiatric symptoms in the least restrictive environment.
These services may be used as a step-up from traditional outpatient care or as a step-down from higher-intensity services (for example, inpatient hospitalization or residential treatment), with the goal of preventing inpatient admissions while delivering care in community or home settings.
Definitions
Level of Care Criteria
Treatment Modalities
AIS/CFIT service package
Services listed are examples and not exhaustive
Visit Limits
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