CurrentFidelis CarePolicy N/A

Children and Family Treatment and Support Services (CFTSS) coverage criteria

Defines coverage expansion by Fidelis Care for Children and Family Treatment and Support Services (CFTSS) for members under age 21, describing service types, settings, and who may provide them.

Policy Summary

PayerFidelis Care

PolicyChildren and Family Treatment and Support Services (CFTSS) coverage criteria

Policy CodePolicy N/A

Change TypeCoverage expansionadded provider types

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionContact Fidelis Care Member Services at 1-888-FIDELIS for information about access and authorization for these services.

SourceLink

POLICY UPDATE CHANGES

Fidelis Care will cover additional Children and Family Treatment and Support Services (CFTSS) beginning January 1, 2020.

Specific youth peer and recovery peer advocate delivered services (youth peer advocate or certified recovery peer advocate) are included.

age < 21eligible population

2020-01-01coverage start

1-888-FIDELISmember services

Coverage Criteria for CFTSS

Covered CFTSS Services

Covered when ALL of the following are met:

Eligibility: Member is a child or youth under 21 years of ageage < 21

From policy: services intended for children under 21.

Service types: Included services include youth support and training (delivered by Youth Peer Advocate or Certified Recovery Peer Advocate), skill development for health problem solving and self-sufficiency, decision-making training, linkage to natural supports, transition planning to adult health care, and in-home/community crisis interventions

List of services available starting 1/1/2020.

Setting and delivery: Services are provided in home or community settings and can include crisis response when family or informal supports are unable to assist

Policy Summary

PayerFidelis Care

PolicyChildren and Family Treatment and Support Services (CFTSS) coverage criteria

Policy CodePolicy N/A

Change TypeCoverage expansionadded provider types

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionContact Fidelis Care Member Services at 1-888-FIDELIS for information about access and authorization for these services.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Policy states home and community delivery and crisis measures.

Fidelis Care covers expanded Children and Family Treatment and Support Services (CFTSS) effective January 1, 2020 for members under age 21. Covered services are behavioral health supports delivered in the home or community and are intended to help children and their families improve health, wellbeing, and quality of life when treating behavioral disorders. Examples of included services are youth peer support and certified recovery peer advocacy, skill development for health problem solving and self‑sufficiency, decision‑making training, linkage to natural supports, transition planning to adult care, and in‑home/community crisis interventions.

The policy text does not list any explicit exclusions or conditions described as not medically necessary in the provided document. Coverage is described specifically for children and youth under 21 and for the CFTSS service types and settings noted; services falling outside that described scope (for example, for members aged 21 or older) are not within this coverage expansion.

Coding and Billing

No explicit codes listedmixed

No codes listed

Provider Actions and Contact

Denial Risk

Coverage limitation

For services that are part of CFTSS: these services are intended for members under 21 years of age. Services not targeted to children under 21 or services outside the scope of Children and Family Treatment and Support Services (CFTSS) may not be covered.

Prior Authorization

Provider action required

Providers should take action to ensure services meet CFTSS eligibility and documentation requirements before delivering care. Verify member age and that services are within the CFTSS scope to avoid claim denials.

Note

Authorization / Member Services Contact

Members and providers with questions about coverage, authorization, or to request services may contact Fidelis Care Member Services at 1-888-FIDELIS (1-888-343-3547). TTY: 711. Member Services can assist with access, prior authorization guidance, and benefit questions.

Note

Member/provider contact reminder

If a member is already receiving CFTSS services, existing service levels are not expected to change with the expanded coverage. For new service requests, confirm CFTSS eligibility and contact Member Services for authorization details.

Background

Children and Family Treatment and Support Services (CFTSS) are behavioral health services designed to support children and their families in managing behavioral health needs. The services aim to improve health, wellbeing, and quality of life and may be provided in the home or community. CFTSS includes peer‑delivered supports provided by licensed Youth Peer Advocates or Certified Recovery Peer Advocates who have lived experience, as well as skill‑building, decision‑making training, linkage to natural supports, transition planning, and crisis interventions when family or informal supports are unable to assist.

Definitions

Peer-delivered support — Youth Peer Advocate / Certified Recovery Peer Advocate

DefinitionYouth Peer Advocate / Certified Recovery Peer Advocate: licensed specialists with lived experience who provide peer-focused support and training to children and adolescents.

RoleProvide youth-focused support and training as part of CFTSS, helping young people with skill development, decision-making, and linkage to supports.

SettingServices delivered in home or community settings as part of Children and Family Treatment and Support Services (CFTSS).

Target populationChildren and youth under 21 who need CFTSS.

Effective dateIncluded as a covered provider type beginning January 1, 2020.

Level of Care — Home/Community Services

Treatment Modalities

Peer-delivered support and in-home/community crisis intervention

Peer and crisis modalities: Youth peer support and certified recovery peer advocate-delivered services; in-home or community crisis intervention including support to implement crisis plans and prevent or de-escalate crises

Described modalities include peer-delivered support and crisis measures when family or informal supports cannot assist.

Visit Limits and Frequencies

Visit limits

Visit/frequency limitNo visit or frequency limits specified in the provided text.

ImplicationContinued services are implied when ongoing support, skill development, crisis prevention, or transition planning is required, but specific limits are not stated.

Scope noteApplies to CFTSS delivered in home or community to members under 21.