CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) Coverage Criteria

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.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAdult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) Coverage Criteria

Policy CodePolicy N/A

Change TypeAdministrative review — no material changes

Effective DateMay 2, 2024

Next Review DateJul 2, 2024

Key ActionContact BCBSRI Behavioral Health Utilization Management at 1-800-274-2958 to determine program access and benefits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 hrs/wkminimum service provision for AIS

6 hrs/wkminimum service provision for CFIT

under 19CFIT age limit

Commercial onlyapplicability

per diemreimbursement method

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Coverage Criteria

Coverage with criteria

Covered when ALL of the following apply

Population: Member is a commercial product beneficiary; for CFIT, member is a covered dependent child under 19

Commercial products only; CFIT age limit applies

Clinical need: Member is experiencing moderate to severe psychiatric symptoms and requires intensive community-based treatment to avoid inpatient/residential care

Services generally for members not at imminent risk of serious harm; may have difficulty performing activities of daily living

Service intensity: Program provides a minimum of six (6) contact hours per week6 contact hours/week

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

Reimbursementmixed

No codes listed

Reimbursement methodmixed

all-inclusive per diem

The provider will be reimbursed at an all-inclusive per diem payment schedule.

Provider Actions and Requirements

Note

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

Prior Authorization

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

Note

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

AIS/CFIT — programs offering intensive home- and community-based behavioral health services

DefinitionPrograms offering intensive home- and community-based behavioral health services to reduce inpatient admissions and provide treatment in less restrictive settings.

Core servicesMay include individual, family, and/or group therapy; medication consultation and management; case management coordination; 24/7 emergency crisis evaluation; psychiatric assessment.

Target populationAdults and children experiencing moderate to severe psychiatric symptoms who require intensive community-based treatment.

Policy applicabilityThis policy applies to Commercial products only.

Level of Care Criteria

Treatment Modalities

AIS/CFIT service package

Modalities: Individual, family, and/or group therapy; medication consultation and management; case management coordination; 24/7 emergency crisis evaluation; psychiatric assessment

Services listed are examples and not exhaustive

Visit Limits

AIS and CFIT programs — minimum 6 contact hours

Minimum weekly contact hours (AIS)Minimum of six (6) contact hours per week.

Minimum weekly contact hours (CFIT)Minimum of six (6) contact hours per week.

CFIT age eligibilityCFIT benefits available only to covered dependent children until their nineteenth (19th) birthday.

Continued eligibility noteContinued eligibility tied to ongoing clinical need and demonstration of benefit from the minimum intensity of six contact hours per week.