CurrentSouth Carolina Department of Health and Human ServicesPolicy N/A

Homebuilders® — Intensive In‑Home Services (Coverage Criteria)

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Defines the Homebuilders® evidence-based intensive in-home service for families with children birth to 18 at imminent risk of out-of-home placement or reunifying after placement; describes program components, eligibility, fidelity, and assessment requirements for providers seeking reimbursement through SC Medicaid.

Policy Summary

PayerSouth Carolina Department of Health and Human Services

PolicyHomebuilders® — Intensive In‑Home Services (Coverage Criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders must enroll as Rehabilitative Behavioral Health Services providers with SC Healthy Connections Medicaid and meet RBHS enrollment, documentation, and Homebuilders® fidelity requirements to bill under H2022‑U4.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4-6 wksstandard duration

20initial per diems

8-10 hrsface-to-face/week

24/7

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CurrentSouth Carolina Department of Health and Human ServicesPolicy N/A

Homebuilders® — Intensive In‑Home Services (Coverage Criteria)

Customize your policy alerts

Sign up for all South Carolina Department of Health and Human Services policy alerts

Know when South Carolina Department of Health and Human Services releases new policies or updates existing guidance.

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Policy Summary

PayerSouth Carolina Department of Health and Human Services

PolicyHomebuilders® — Intensive In‑Home Services (Coverage Criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4-6 wksstandard duration

20initial per diems

8-10 hrsface-to-face/week

24/7

2 familiestypical caseload

Coverage Criteria — Medical Necessity and Program Requirements

Medical Necessity / Eligibility

Covered when ALL of the following are met

Eligibility for Homebuilders®: Child is at risk of, or returning from, placement in foster care, group care, PRTF, psychiatric hospital, or juvenile justice facility as determined by the referring agency; the referring agency has determined that without intensive in‑home services the child would be placed out of home or cannot safely return home; the family is available and consents to participate in an intensive 4–6 week intervention and at least one caregiver is willing to meet with the Homebuilders® provider; intensive in‑home services are expected to allow the child to remain safely in the home (no imminent harm if services provided); less intensive services do not sufficiently reduce placement risk, are unavailable, or have been exhausted; for reunification referrals, the child will be returned to the family within 7 days of the start of services.

Model fidelity and service components

Covered when services follow the Homebuilders® model and include the following core elements:

Core program elements: Engagement using motivational interviewing; member‑directed assessment across life domains and ongoing safety assessment and planning (including domestic violence and suicide assessment); behavior change using evidence‑based cognitive and behavioral interventions (e.g., CBT, behavioral parent training, relapse prevention); skills development through teaching interaction (demonstration, practice, feedback, homework); provision of concrete supports/services tied to goals; community coordination and advocacy; services provided primarily in the family's natural environment (home or community locations); time‑limited intensive delivery with low caseloads (specialists typically carry two families).

Derived from Homebuilders® core strategies and caseload guidance.

Time-limited intensive intervention

Service delivery and intensity specifications:

Service intensity/duration: Provide a time‑limited intensive intervention of approximately 4–6 weeks with up to two booster sessions as indicated; specialists typically serve two families at a time; typical total service provision is approximately 80 hours with an average of ~38 face‑to‑face hours (service intensity varies by family needs).4-6 weeks; ~80 hours; ~38 face-to-face hours

Service intensity varies across families based on identified needs.

Initial Service Plan Criteria

Service Plan requirements — Covered when ALL of the following are met

Service Plan timing: A Service Plan is developed collaboratively with the family and relevant collateral supports within the second week of services.within 2 weeks

[[40]]

Service Plan content: Service Plan includes a behaviorally specific problem statement, the domain (environment, parental capabilities, family interactions, family safety, or child wellbeing), measurable goals and outcomes, and an action plan describing staff actions to help the family reach goals; the plan is updated as needed and incorporates safety planning.

[[40]]

NCFAS alignment: Goals must address any NCFAS domains scored below baseline/adequate (score = 0) when related to the reason for referral; the NCFAS Assessment and Service Plan are shared with the contracting agency fourteen days after intervention start; Service Summary with post‑NCFAS is shared seven days after case closure.NCFAS score = 0; Service Plan shared within 14 days; Service Summary shared within 7 days

Action Plans and Indicators

Action plans and indicators of goal achievement (examples provided for common domains)

Home condition goals: Action plans: active listening, motivational interviewing, psychoeducation about safety, practical supports (e.g., installing locks), and progress maintenance planning. Indicators: use of locks, removal of hazards, reduction of infestations, parent report and/or specialist observation of learned safety practices.

[[44],[45]]

Parenting skills: Action plans: psychoeducation, modeling, timeout procedures, positive reinforcement, planned ignoring, practice opportunities, and homework. Indicators: parent demonstration of strategies (e.g., 'when/then', time‑out), articulation of child development concepts, and observed use of parenting techniques.

[[46]]

Emotion management: Action plans: psychoeducation, modeling, cognitive techniques (REBT), and new coping skills practice. Indicators: parent use of positive affirmations, challenging negative self‑talk, and application of coping strategies as reported and observed.

[[47]]

Closure and Extension Criteria

At transition/closure — ALL of the following must be completed

Maintenance plan and referrals: Specialist develops a written Progress Maintenance Plan with the family to maintain progress and identify unmet/ongoing needs; specialist assists family in connecting to community resources in consultation with the referring agency; a team meeting is held to ensure agreement and accountability.

[[52]]

Extension justification: Extension of Homebuilders® considered only if out‑of‑home placement remains imminent, the family has active treatment goals they wish to pursue, and no community resources can meet those goals; or if specialist/supervisor/family believe termination poses high risk of reemergence of imminent placement risk; documentation must demonstrate assessment and determination supporting extension.

[[52]]

Service Summary and surveys: Complete Service Summary including post‑NCFAS ratings and goal assessment, provide Family Satisfaction and Referring Worker Surveys, retain completed copies in the case record, and email the Service Summary to the referent within seven days of case closure.Service Summary emailed within 7 days

Services that do not adhere to the Homebuilders® model standards and fidelity measures are not eligible for reimbursement through South Carolina Healthy Connections Medicaid. Providers must deliver the program consistent with IFD/Homebuilders® fidelity expectations (including required consultation and supervision) to qualify for payment; deviations from the model that compromise fidelity may result in denial of reimbursement.

Within the excerpted policy text there are no other explicit exclusions listed beyond model-fidelity and overlap restrictions. The document does not present a standalone list of clinical exclusions in this section; instead, it notes service-specific restrictions and reimbursement limits where applicable.

The provided sections do not state specific clinical exclusions (for example, diagnostic or comorbidity-based exclusions) that would automatically render a referral ineligible. Instead, continuation or extension decisions are tied to documented risk status, treatment goals, and availability of community resources rather than fixed clinical exclusion criteria.

The provider accreditation exemption is narrowly defined: agencies that exclusively provide the evidence-based Homebuilders® practice may be exempt from CARF, TJC, or COA accreditation only if they maintain good standing with the Institute for Family Development (IFD) and fidelity to the Homebuilders® model as verified by the referring SC state agency or SCDHHS. Agencies providing services outside the Homebuilders® model must meet the standard RBHS accreditation requirements.

Vocational supports delivered within a Homebuilders® episode are not reimbursable through Homebuilders® when equivalent employment services are available through other programs (for example, Vocational Rehabilitation). Providers should avoid billing Homebuilders® per diems for vocational activities that are the responsibility of other funded programs.

Homebuilders® is intended to be comprehensive of most RBHS services while preserving access to certain specialized services. The policy lists exceptions that may be provided separately by qualified providers (and must not be provided concurrently with Homebuilders®), including psychological evaluation/testing, psychiatric evaluation and management, medication management, peer support, assertive community treatment, psychosocial rehabilitation services, community integration services, behavior modification, therapeutic childcare, therapeutic foster care, individual psychotherapy, and group psychotherapy. When these services are delivered separately, they must be provided by appropriately qualified providers and scheduling concurrently with Homebuilders® care is prohibited as specified.

The policy explicitly prohibits providing certain listed services concurrently with Homebuilders®; concurrent provision of those services is a trigger for denial. Providers must ensure that services identified in the exclusions/restrictions section are not billed or delivered at the same time as Homebuilders® to avoid claim denial.

No explicit 'not medically necessary' statements appear in the excerpted sections. Instead, eligibility and continued-need determinations are described in terms of documented imminent risk of out-of-home placement, demonstrated medical necessity via the NCFAS assessment and treatment goals, model fidelity, and appropriate documentation; lack of demonstrated eligibility or departure from fidelity may lead to denial.

Billing Codes, Per-Diems, and Episode Limits

Billing CPT/HCPCS for Homebuilders®HCPCSCovered

H2022-U4

Intensive In-Home Services with Homebuilders® modifier (per document)

Required procedure/modifier for Homebuilders® crisis interventionHCPCSCovered

H2022-U4

Intensive In-Home Services with Homebuilders® modifier

inv-20: Standard episode per diems — 20 per diems over no more than 6 weeks

Standard episode limitUp to 20 per diems per episode, delivered over no more than 6 weeks

Per-diem unitPer diem reimbursed once per calendar day and covers all Homebuilders® activities provided that day

Authorization implicationAdditional per diems beyond 20 require documentation meeting continuing stay criteria and approval

inv-21: Initial per diem limit — 20 per diems over no more than 6 weeks

Initial per diem allowanceMember receives up to 20 per diems of Homebuilders® services

Timeframe for initial per diems

Provider Responsibilities, Authorization, and Documentation

Prior Authorization

Duration extensions require consultant/supervisor approval and model fidelity

Extensions beyond the standard four- to six-week duration require approval by the Homebuilders® consultant or a trained team supervisor; providers must maintain program fidelity to IFD/Homebuilders® standards for reimbursement eligibility.

Document extension justification demonstrating ongoing imminent risk or unmet treatment goals and lack of community resources.
Obtain consultant/supervisor approval before billing additional per diems.

Denial Risk

Ensure referral/documentation shows placement risk or exhaustion of less intensive options

If referral or documentation does not demonstrate the child is at risk of, or returning from, placement in foster care, group care, PRTF, psychiatric hospitalization, or juvenile justice facilities—or that less intensive services are insufficient or unavailable—eligibility is not demonstrated and services may be denied.

Program Background and Scope

Background: Homebuilders® is an evidence-based, intensive in-home intervention that combines motivational interviewing, cognitive-behavioral techniques, relapse prevention, and skills training to improve parenting, family interactions, child behavior, safety, and access to supports. The model targets families with children birth through 18 who are at imminent risk of out-of-home placement or who require reunification supports, and emphasizes immediate response to referral with therapist and supervisor availability 24/7.

Key Definitions and Terms

inv-49: Homebuilders® — Intensive in-home evidence-based practice focused on families with children birth to 18 at imminent risk of out-of-home placement.

DefinitionAn intensive in-home, evidence-based practice for families with children birth to 18 at imminent risk of out-of-home placement or reunifying after placement

Core strategiesUses motivational interviewing, cognitive and behavioral interventions, relapse prevention, skills training, and access to basic needs/supports

inv-50: NCFAS v.2 — The North Carolina Family Assessment Scale (NCFAS v.2) validated assessment framework used to assess family functioning domains.

Tool nameNorth Carolina Family Assessment Scale (NCFAS v.2)

PurposeValidated framework used to assess family strengths and problems across five domains and to guide Service Plan development

Use in program

Level of Care — Eligibility Bands and Placement Risk

Intensive in-home

Covered when delivered according to the Homebuilders® model and IFD standards with required documentation and authorization

Core coverage requirements: Services billed under HCPCS H2022‑U4 as a per diem; a Homebuilders® billable activity must occur on the calendar day billed; standard episodes limited to 20 per diems over no more than 6 weeks; additional per diems or extensions require documentation meeting continuing stay criteria and, where applicable, approval via the Request for Approval of Continued Services/Booster Sessions process. Telephonic service time may be billed but must not represent the majority of overall service time; crisis services within Homebuilders® are billed under the same code/modifier.20 per diems; <=6 weeks

Telephonic contacts allowed but should be limited; crisis billed under H2022‑U4.

In-home intensive family preservation / Home-based services

Provider and access requirements: Accept referrals 24/7 with therapist and supervisor availability; providers must enroll as Rehabilitative Behavioral Health Services providers through SC Healthy Connections Medicaid and meet RBHS provider manual enrollment and licensing requirements; Homebuilders® Specialists and Supervisors must meet specified education and experience qualifications.

Permitted Treatment Modalities and Program Components

Homebuilders® interventions

Core Homebuilders® interventions: Deliver evidence‑based Homebuilders® interventions including motivational interviewing, cognitive and behavioral strategies, relapse prevention, skills training, concrete supports, and community coordination to reduce imminent risk of out‑of‑home placement and support reunification.

[[1],[2]]

In-home therapy and family skills training

In‑home therapy and family skills training: Use motivational interviewing, behavioral parent training, CBT strategies, relapse prevention, teaching interaction (demonstration, practice, feedback), and homework to develop parenting and child behavior management skills and daily routines.

[[28],[29]]

Psychosocial interventions

Visit Limits, Caseloads, Duration, and Follow-Up

inv-71: face-to-face Homebuilders® sessions — 3-5+ sessions per week; average 8-10 face-to-face hours per week

Session frequency3-5 or more sessions per week based on identified goals and needs

Average weekly face-to-face hoursAn average of 8-10 hours per week of face-to-face contact

Documentation notePlanned Homebuilders® sessions may be documented in a single service note for each day of billable activity

inv-72: aftercare booster sessions — Two aftercare booster sessions totaling five hours available within six months post-referral; additional boosters require consultant approval

Number and durationTwo aftercare booster sessions totaling five hours available within six months post-referral

Additional boosters

Policy Summary

PayerSouth Carolina Department of Health and Human Services

PolicyHomebuilders® — Intensive In‑Home Services (Coverage Criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Range of goal-directed services: Staff provide goal‑directed services including risk assessment and development of behaviorally specific safety plans to address issues contributing to danger of placement or barriers to reunification.

[[42]]

Decision-making: Action plans: psychoeducation, DBT skills, decisional balance activities, and distress tolerance practice. Indicators: use of identified decision‑making skills and DBT strategies in real situations.

Safety skills: Action plans: develop Safety Plans, domestic violence psychoeducation, increase natural supports, youth personal safety education, and installation of safety devices. Indicators: demonstrated use of Safety Plan steps, installation/use of locks/alarms/cameras, and reliance on natural supports.

[[49]]

Relapse prevention: Action plans: develop Relapse Prevention Plan, identify triggers and replacement activities, support for urine drug screens if requested, and assign homework. Indicators: use of replacement activities, engagement in self‑care, and negative drug screens when requested.

[[50]]

Communication skills: Action plans: introduce 'I' statements, active listening, role‑play, and tools such as feeling thermometers. Indicators: parent use of 'I' statements, role‑play participation, and use of feeling thermometer to identify and manage emotions.

[[50],[51]]

The initial 20 per diems must be provided over no more than 6 weeks

Billing requirementA Homebuilders® billable activity must occur on the calendar day billed for the per diem to be reimbursable

Prior Authorization

Enroll as RBHS provider and meet Medicaid licensing requirements

Provider agencies must enroll as Rehabilitative Behavioral Health Services (RBHS) providers through SC Healthy Connections Medicaid and meet the Medicaid enrollment and licensing requirements in the RBHS provider manual.

Maintain any required qualifications in the 'Provider Medicaid Enrollment and Licensing' section (Chapter 3) of the RBHS provider manual.

Billing Rule

Bill H2022-U4 per diem; 20 per diems standard episode

Bill Homebuilders® under the Intensive In-Home Services procedure code with the Homebuilders® modifier (H2022-U4); reimbursement is a per diem that requires a Homebuilders® billable activity on the calendar day billed.

Standard authorization supports up to 20 per diems over no more than 6 weeks; additional per diems require documentation meeting continuing-stay criteria.
Per diems are reimbursed once per calendar day and cover all Homebuilders® activities on that day.

Prior Authorization

Submit continued-stay/booster request form signed by supervisor and consultant

Requests for service extension or post-termination booster sessions must be submitted on the 'Request for Approval of Continued Services/Booster Sessions' form, signed by the Homebuilders® Supervisor and IFD consultant, and approved by SCDHHS Office of Behavioral Health.

Attach the approved form to the first claim submitted after the initial 20 per diems are exhausted and submit via the Medicaid webtool.
Additional documentation may be requested to verify need.

Step Therapy

Document prior use or insufficiency of less intensive services

Homebuilders® is indicated when less intensive services do not sufficiently reduce the risk of placement, are unavailable, or have been exhausted; document this as part of medical necessity for referral.

Step Therapy

No step therapy sequence required

No formal step therapy requirements are described; the program emphasizes immediate intensive, evidence-based services when families meet Homebuilders® eligibility.

Denial Risk

Document justification for extensions (imminent risk or unmet goals)

Any extension must be documented showing continued imminent risk of out-of-home placement or that treatment goals remain unmet and community resources cannot meet the family's needs.

Documentation must carefully demonstrate the assessment process and determination that extension is appropriate.

Note

Refer members to higher‑intensity services when indicated

Refer or link members to appropriate higher-intensity behavioral health services when assessments indicate needs beyond Homebuilders® scope.

Make referrals when member needs escalate to services such as higher levels of care per standard clinical judgment.

Note

Allow re‑referral when NCFAS shows ongoing medical necessity

Families may be re‑referred to Homebuilders® if they continue to meet eligibility criteria and medical necessity as identified by the NCFAS; ensure NCFAS demonstrates ongoing need.

Re-referral requires documentation that family still meets NCFAS-based medical necessity.

Documentation Required

Perform behaviorally specific, multi-source assessment using NCFAS v.2

Conduct behaviorally specific, interactive, holistic assessments using multiple sources (direct observation, county DSS, collateral contacts, family) and the NCFAS v.2 framework to document safety, strengths, and needs.

Assessment is ongoing from referral through termination and informs the Service Plan and NCFAS ratings.

Documentation Required

Document NCFAS-based assessment and outcomes (pre/post)

Use the NCFAS as pre/post outcome measurement and to summarize case conceptualization; document member-directed assessment across life domains, ongoing safety assessment and planning, domestic violence and suicide assessments, crisis planning, and goal-directed interventions.

Include NCFAS pre- and post-ratings in the record to guide treatment planning and evaluate outcomes.

Documentation Required

Complete Service Plan/NCFAS/Service Summary and meet sharing timelines

Complete and maintain Service Plan, NCFAS Assessment, and Service Summary (with post-NCFAS ratings) in the case file; share the NCFAS Assessment and Service Plan with the contracting agency within 14 days of service start and email the Service Summary to the referent within 7 days of case closure.

Keep copies of these documents in the individual case record as required.

Documentation Required

Administer surveys and perform 6‑ and 12‑month follow‑up with documented contact attempts

Provide Family Satisfaction and Referring Worker Surveys at case closure and retain completed forms in the case record; conduct follow-up evaluations at 6 and 12 months and, if a home visit is not possible, document five telephone contact attempts.

Maintain completed survey forms in each case record.
Document five telephone attempts if unable to complete home follow-up visits.

Documentation Required

Use ODM/ECM and follow IFD documentation guidelines

All teams must use the web-based member documentation/data system (ODM/ECM) and adhere to IFD guidelines for documentation submission; documentation must meet Medicaid basic requirements and IFD fidelity standards.

Enter all member documentation into ECM to support fidelity ratings and site reviews.

Documentation Required

Document daily sessions in single service note; separate crisis notes with risk/intervention details

Document planned Homebuilders® sessions in a single service note for each day of billable activity; document crisis services separately with level of risk, crisis assessment/interventions, referrals, and status on completion.

Service notes should include targeted goals, interventions provided, response/progress, and plans for the next session.
Time spent on non-billable model activities is included in the per diem and must not be billed separately.

Used as pre/post measurement to observe change and summarize case conceptualization

inv-51: Homebuilders® Specialist / Specialist / Provider — Terms used interchangeably to refer to staff delivering the Homebuilders® interventions.

TerminologyThe terms 'Homebuilders® Specialist', 'Specialist', and 'Provider' are used interchangeably to refer to staff delivering Homebuilders® interventions

Caseload implicationSpecialists typically serve two families at a time (low-caseload model)

inv-52: NCFAS — Outcome measurement tool used during assessment and treatment as a pre/post measure to observe change and guide service planning.

FunctionOutcome measurement tool used during assessment and treatment as a pre/post measure to observe change and guide service planning

IntegrationSummarizes overall case conceptualization and informs Service Plan goals and measurable outcomes

ReportingPost-NCFAS ratings are included in the Service Summary at case closure

inv-53: Service Plan — A collaboratively developed plan within two weeks of service start that includes problem statements and domain identification.

TimingService Plan developed collaboratively within the second week of services

ContentsIncludes problem statement, domain (environment, parental capabilities, family interactions, family safety, child wellbeing), measurable goals/outcomes, and action plan

AlignmentGoals must address NCFAS domains scored below baseline/adequate (score = 0) when related to the reason for referral

inv-54: Service Summary — A summary including post-NCFAS ratings and goal assessment completed at case closure and emailed to the referent within seven days; retained in file.

Service Summary contentIncludes post-NCFAS ratings, goal assessment, plan for maintenance of progress, and ongoing needs at case closure

Timing and distributionService Summary with post-NCFAS emailed to the referent within 7 days after case closure; a copy retained in the case file

RecordkeepingCompleted Service Summary and surveys are maintained in the individual case record

inv-55: Per diem (bundled service rate) — A daily bundled reimbursement rate that covers all aspects of Homebuilders® provided on that calendar day; reimbursed once per calendar day.

DefinitionPer diem is a bundled daily reimbursement rate that covers all Homebuilders® services provided on that calendar day

Billing frequencyReimbursed once per calendar day when a billable Homebuilders® activity occurs

ScopeCovers planned sessions, documentation time factored into the rate; non-billable activities are not billed separately

inv-56: Homebuilders® consultant — IFD staff who provide weekly team consultation and 24/7 consultation availability for emergencies.

FunctionsProvide weekly team consultation/supervision, individual supervision support to supervisors, and emergency consultation as needed

QualificationHomebuilders® consultants have extensive experience delivering, supervising, and/or managing Homebuilders® programs

inv-58: Billing for crisis intervention within Homebuilders® — Crisis intervention services provided within a Homebuilders® episode should be billed under the HCPC procedure code for Intensive In-Home services with the Homebuilders® modifier.

Billing ruleCrisis intervention within a Homebuilders® episode should be billed under the Intensive In-Home Services procedure code with the Homebuilders® modifier (H2022-U4)

In-person or telephonicIn-person or telephonic service time between provider and child/family may be billed; telephonic time must not represent the majority of overall service time

Child presenceThe child is not required to be present for billing of in-person or telephonic contacts within the episode

inv-58: Homebuilders® services — Homebuilders® (general term).

General termHomebuilders® refers to the intensive in-home evidence-based program described in this policy

Target populationFamilies with children birth to 18 at imminent risk of out-of-home placement or reunifying after placement

Home-based family intervention (Homebuilders®)

Homebuilders® intervention modalities: Use motivational interviewing, cognitive and behavioral interventions, relapse prevention, skills training, behavioral parent training, psychoeducation, modeling, and practical supports to improve parenting, family functioning, child behavior, and safety; deliver services primarily in the home and natural environments.

[[1],[2],[25]]

Intensive In-Home (Homebuilders®)

Intensive In‑Home (Homebuilders®) billing and episode rules: Standard authorization supports up to 20 per diems over no more than 6 weeks; additional per diems require documentation meeting continuing stay criteria; in‑person or telephonic service time is billable (child not required to be present) but telephonic contacts must not comprise the majority of service time; re‑referrals allowed when NCFAS indicates ongoing medical necessity.20 per diems; <=6 weeks

[[35],[72],[76]]

Intensive In-Home (Homebuilders®)

Per‑diem episode and continued stay process: Initial episodes are limited to 20 per diems over no more than 6 weeks; requests for additional per diems or booster sessions must include the completed 'Request for Approval of Continued Services/Booster Sessions' form signed by the Homebuilders® Supervisor and IFD consultant, attached to the first claim after the initial 20 per diems via the Medicaid webtool; SCDHHS Office of Behavioral Health approves extensions.form attached to claim after 20 per diems

[[72],[77],[76]]

Multiple levels (Outpatient to Inpatient/Residential)

Multiple levels - continued stay applicability: Headings indicate continued stay criteria and booster sessions apply to: Individual Psychotherapy; Group Psychotherapy (may be provided separately but must not be concurrent with Homebuilders®); Family Psychotherapy; Multisystemic Therapy; Acute Psychiatric Hospitalization; Psychiatric Residential Treatment Facility; Medicaid Targeted Case Management. Detailed continued‑stay criteria for these services are not provided in this section.

[[90-96]]

Psychosocial interventions: Interventions include psychoeducation, modeling, skills practice (communication, emotion regulation, decision‑making), REBT techniques, DBT skills, safety planning, and relapse prevention strategies matched to the family's identified goals.

[[44],[46],[47],[48],[50]]

Intensive In-Home Services / Crisis within Homebuilders®

Crisis within Homebuilders®: Crisis intervention services provided within a Homebuilders® episode should be billed under H2022‑U4 with the Homebuilders® modifier; crisis contacts (in‑person or telephonic) between provider and child/family are billable but telephonic contacts must not represent the majority of service time and should be used as appropriate for crisis management.

[[71],[73]]

Crisis intervention / Intensive In-Home Services

Crisis intervention rules: Crisis intervention within Homebuilders® episodes billed under Intensive In‑Home Services with modifier H2022‑U4; in‑person or telephonic time between provider and family is billable when appropriate and with family engagement, and telephonic service should not be the majority of service time.

[[73],[76]]

Individual, Group, Family Psychotherapy

Psychotherapy modalities and booster applicability: Individual, Group, and Family Psychotherapy modalities are listed as services for which continued stay criteria and booster sessions apply; Group Psychotherapy may be provided separately for members in Homebuilders® but must not be provided concurrently with Homebuilders® when prohibited.

[[90],[91],[92]]

Additional booster sessions beyond the two may be approved by the Homebuilders® consultant

Approval mechanismRequests for post-termination booster sessions require appropriate documentation and consultant/supervisor approval

inv-73: Homebuilders® specialist caseload — Typically serve two families at a time

Typical caseloadHomebuilders® specialists typically carry caseloads of two families at a time

Model implicationLow caseload supports time-limited, intensive delivery and fidelity to the model

Service intensitySpecialists provide intensive support during the episode consistent with model standards

inv-74: Intensive Homebuilders® intervention — 4-6 weeks (+ up to two booster sessions)

Typical durationIntensive Homebuilders® intervention is provided for 4–6 weeks

Booster sessionsUp to two booster sessions are available following the intensive intervention

Extension policyExtensions beyond 4 weeks must be approved by the Homebuilders® consultant or trained team supervisor and require documentation

inv-75: Telephone contact attempts for 6- and 12-month follow-up if home visit not possible — Five

Follow-up attemptsIf a home visit is not possible for 6- or 12-month follow-up, five telephone contact attempts must be made and documented

Follow-up timingFollow-up evaluations occur at six and twelve months after case termination

DocumentationCompleted follow-up attempts and evaluations are retained in the case record

inv-76: Homebuilders® per diems — 20

Per diems per episode20 per diems per episode (standard)

Episode timeframeProvided over no more than 6 weeks unless additional per diems are approved

Approval for extra per diemsAdditional per diems require documentation meeting continuing stay criteria and approval

inv-77: per diems (Homebuilders®) — 20

Per diem countStandard initial per diems authorized: 20

Maximum standard timeframeNo more than 6 weeks for the initial 20 per diems

Billing code contextPer diems are billed under H2022-U4 (Intensive In-Home Services with Homebuilders® modifier)

inv-78: face-to-face contact — 8-10 hours

Typical face-to-face hoursApproximately 8–10 face-to-face hours per week (average)

Average total face-to-face hoursServices average about 38 face-to-face hours over the intervention

Service schedulingSessions scheduled day, evening, and weekends as needed to meet family goals and safety needs