Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) Coverage Criteria
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Defines coverage, service expectations, and admission notification requirements for AIS and CFIT home- and community-based behavioral health services for adults and dependent children covered by BCBSRI commercial products.
No material clinical or coverage changes in this revision.
Coverage Criteria
Covered Services
Covered when program and eligibility conditions are met:
See member Benefit Booklet/Subscriber Agreement for benefit applicability
These modalities are examples and are not exclusive
CFIT limited to covered dependent children until 19th birthday
Benefits for Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) may vary by group or contract. Refer to the member Benefit Booklet or Subscriber Agreement for the specific behavioral health benefits and coverage that apply to the member.
If services are determined to be not medically necessary or are non-covered benefits, the member must not be charged for those services unless the member has been informed and has provided advance written agreement to assume the cost. Benefits and eligibility are governed by the member's subscriber agreement or member certificate, which supersede this policy.
Coding and Reimbursement
| per diem | All-inclusive per diem payment schedule |
Provider Actions and Notifications
Admission notification required — notify BCBSRI Behavioral Health Utilization Management
Notification of Admission is required for both in-network and out-of-network AIS/CFIT services. Providers must notify BCBSRI Behavioral Health Utilization Management within 48 hours of a member's admission to ensure correct claims processing and care coordination.
- Contact BCBSRI Behavioral Health Utilization Management: 1-800-274-2958
- Applicable to Commercial products only
Clinical sequencing — AIS/CFIT as step-up/step-down relative to other levels of care
AIS and CFIT may be used as a step-up from traditional outpatient services or a step-down from more intensive levels of care (for example, inpatient hospitalization or residential treatment). Coordinate with BCBSRI Behavioral Health Utilization Management regarding clinical sequencing and transitions of care to support appropriate level-of-care decisions.
- AIS/CFIT intended to provide intensive treatment in the least restrictive environment
- Use as step-up from outpatient or step-down from inpatient/residential
Supporting documentation — refer to member Benefit Booklet or Subscriber Agreement; documentation expectations
Supporting documentation for medical necessity, benefits, and eligibility is driven by the member's Benefit Booklet, Subscriber Agreement, and employer agreement. Providers must maintain and furnish clinical records, progress notes, treatment plans, admission and discharge summaries, and any prior authorization or notification confirmations upon request. Failure to provide requested documentation may result in denied or delayed claims.
- Refer to the member's Benefit Booklet or Subscriber Agreement for coverage specifics
- Keep clinical records: progress notes, treatment plans, admission/discharge summaries
- Provide prior authorization/notification confirmations when requested
Notification requirement — failure to notify within 48 hours may lead to incorrect claims processing and other risks
Failure to notify BCBSRI Behavioral Health Utilization Management within 48 hours of admission may lead to incorrect claims processing, delayed payment, or other administrative risks. Providers should ensure timely notification to avoid billing issues and to facilitate appropriate utilization management.
- Late or missed notification may affect claims adjudication and member liability
- Notify within 48 hours to reduce risk of denial or payment delay
Background
Adult Intensive Services (AIS) and Child and Family Intensive Treatment (CFIT) are home- and community-based programs designed to provide intensive behavioral health treatment in the least restrictive setting to adults and dependent children with moderate to severe psychiatric symptoms. These services aim to reduce inpatient admissions and support stabilization by delivering multimodal interventions in community, office, or home settings.
Services commonly include individual, family, and/or group therapy; medication consultation and management; case management coordination; 24/7 emergency crisis evaluation; and psychiatric assessment. AIS and CFIT may serve as a step up from traditional outpatient care or a step down from more intensive services, depending on clinical need.
Program requirements include notification to BCBSRI Behavioral Health Utilization Management within 48 hours of admission and a minimum service intensity of six (6) contact hours per week to qualify and continue as AIS/CFIT services. CFIT benefits are limited to dependent children and apply until the member's 19th birthday. Refer to the member Benefit Booklet/Subscriber Agreement for benefit applicability and for member-specific eligibility determinations.
Definitions
Home- and Community-Based Intensive Services Criteria
Home- and community-based intensive services (AIS/CFIT)
Level-of-care criteria for admission, continued stay, and discharge for home- and community-based intensive services (AIS/CFIT):
Contact BCBSRI Behavioral Health Utilization Management at 1-800-274-2958
Typically not at immediate risk of serious harm but may have functional impairment
Applies to both AIS and CFIT
Applies only to CFIT
Treatment Modalities
Multimodal behavioral interventions
Multimodal behavioral interventions included as part of AIS/CFIT:
These modalities are examples and are not exclusive
Visit Limits and Contact Hours
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