Family Centered Treatment (FCT) — Coverage Criteria
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Defines eligibility, utilization management, documentation, service codes, monitoring, and clinical criteria for Family Centered Treatment (an intensive in-home behavioral health service) for children and adolescents and their families.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity Criteria
Initial Eligibility
Covered when ALL of the following are met
From Eligibility Criteria section
Continued Stay Criteria
Covered for continued stay when ALL of the following apply
From Continued Stay Criteria
From Continued Stay Criteria - progress options
Discharge Criteria
Service discharge when ANY of the following apply
From Discharge Criteria
Targeted Length of Stay and Outcome Payment Eligibility
Outcome payments and targeted length of stay
See exclusions for post-discharge events that void eligibility
Outcome Payment Disqualifiers
Outcome payment eligibility is contingent on absence of certain post-discharge events
These events disqualify outcome payments
Family Centered Treatment (FCT) cannot be provided during the same authorization period as the following services: Outpatient Therapy Services (including Outpatient Plus), In-Home Therapy, Intensive In-Home Services (IIHS), Multisystemic Therapy (MST) including Intercept, Child and Adolescent Day Treatment, Child ACT, and Substance Abuse Intensive Outpatient Program (SAIOP).
Outcome payment eligibility for FCT is voided if, during the episode or following discharge, the member experiences any of the following events: an inpatient admission, a Facility Based Crisis admission, placement in a residential Level II or higher setting (planned or unplanned), or a return to FCT or admission to IIH, MST, Intercept or comparable adult services. These events disqualify three- and six-month outcome payments.
A sole diagnosis of intellectual and developmental disability does not meet eligibility for FCT. Members must have a DSM-5 mental health or substance use disorder diagnosis (i.e., FCT is covered only when there is a qualifying co-occurring DSM-5 diagnosis beyond intellectual/developmental disability).
Service and Outcome Codes
Provider Requirements, Authorization, and Documentation
Prior authorization and unit limits
Prior authorization is not required for the initial six months of FCT. Initial authorization is one unit per month and may not exceed six units; reauthorizations may not exceed 60 days. Outcome reporting codes (H2022 U5 U3 and H2022 U5 U4) are reported without prior authorization.
Service setting and telehealth approval
FCT is delivered in-person in homes and community settings. Telehealth delivery is allowable only with the direction and approval of the FCT Foundation.
- Service setting: in-person, home- and community-based.
- Telehealth permitted only with FCT Foundation direction and approval.
Prior outpatient treatment requirement
Outpatient treatment services should have been considered or previously attempted and found inappropriate or ineffective prior to initiation of FCT; this must be documented in the comprehensive clinical assessment.
- Document that outpatient services were considered or tried and found inadequate.
- Inclusion of this history is part of the Comprehensive Clinical Assessment required prior to service.
Episode length and outcome payment timing
The targeted episode length for FCT is six months (six monthly units). Outcome payments are available for discharges at three and six months for episodes with duration between one and six months.
- Targeted episode length: 6 months (6 monthly units).
- Outcome payments eligible for 3-month and 6-month discharges when episode duration is 1–6 months.
Required clinical and administrative documentation
A Comprehensive Clinical Assessment (CCA) or equivalent addendum demonstrating medical necessity must be completed prior to provision of FCT. Initial requests must include a Service Authorization Request (SAR), Person-Centered Plan (PCP), CCA and crisis plan; continued authorization requests must include an updated PCP. Services require full service notes per the RMDM Chapter 7 and submission of FCT fidelity/adherence documentation.
- Complete CCA or acceptable equivalent prior to service.
- Signed service order in place prior to or on first date of service (valid one year).
- Initial authorization submissions: SAR, PCP, CCA, and crisis plan.
- Continued authorization: updated PCP.
- Document services with full service notes per RMDM Chapter 7 and submit FCT fidelity/adherence documentation.
Provider enrollment and certification documentation
Providers must be enrolled in NC Medicaid (NC Tracks), credentialed and enrolled as a Partners Health Management network provider in good standing, maintain FCT licensure through the FCT Foundation, and ensure staff complete and maintain required FCT certification and recertification (including field observations).
- Enrollment in NC Tracks and participation in NC Medicaid required.
- Credentialing and active enrollment with Partners Health Management Provider Network required.
- Maintain FCT Foundation licensure for the provider agency; staff must maintain certification and recertification including field observations.
FCT not reimbursed during psychiatric inpatient care
FCT will not be reimbursed for dates of service when the member is receiving psychiatric inpatient services; core monthly payment cannot be billed for the same day as a psychiatric inpatient admission, though providers may coordinate discharge planning.
- No reimbursement for core FCT services on dates the member is in psychiatric inpatient care.
- Providers may facilitate coordination of discharge plans but cannot claim core payment for the inpatient day.
Outcome payment denial triggers
Outcome payments are ineligible if, following discharge, the member has any inpatient or Facility Based Crisis admissions, is placed in residential Level II or higher (planned or unplanned), or returns to FCT, IIH, MST, Intercept or comparable services.
- Post-discharge inpatient or Facility Based Crisis admissions void outcome payment eligibility.
- Residential Level II or higher placements from discharge (planned or unplanned) void eligibility.
- Return to FCT, admission to IIH, MST, Intercept or comparable services void outcome payments.
Program Background
Family Centered Treatment (FCT) is an evidence-based, intensive in‑home model delivered in the family’s home and community to address severe behavioral and emotional challenges among children and adolescents. FCT is intended to promote family functioning and permanency, prevent or shorten residential/PRTF stays, manage crisis-level symptoms (including suicidal or homicidal ideation, aggression, trauma-related behaviors, self-injury, serious risk-taking, and substance use), and reduce the need for higher levels of care. Services are provided by certified FCT clinicians and require a Comprehensive Clinical Assessment to establish appropriateness; outcome payments are tied to episode duration and are contingent on absence of inpatient, facility-based crisis, or higher‑level residential placements following discharge.
Key Roles and Terms
Level-of-Care Definitions
Intensive In-Home (FCT)
Covered when ALL of the following are met
From Level of Care Criteria - Intensive In-Home (FCT)
Home- and community-based (in-person)
Covered when ALL of the following are met
From Service Type/Setting and Activities
Treatment Components and Supervision
FCT intensive in-home treatment
Covered when ALL of the following are met
From Service Description and Activities
FCT therapy and Wheels of Change certification
Covered when ALL of the following are met
From FCT Counselor / Wheels of Change
FCT supervision
Covered when ALL of the following are met
From FCT Supervisor and Provider Requirements
Units, Episodes, and Visit Limits
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