FAQ for Concurrent Review Updates for Select Child and Family Treatment and Support Services (CFTSS)

After the first three visits, providers must submit the Children and Family Treatment Supports Service (CFTSS) Continuing Authorization Request Form along with the treatment plan to support continued medical necessity.

This document is intended to support understanding of service requirements, documentation expectations, and the concurrent review process for CPST and PSR as part of the Children Family Treatment and Support Services (CFTSS) array.

Key Terms

• Concurrent Review: Concurrent review, or notification is provided while a member is actively receiving treatment or care. Providers must submit requests that, upon review, can result in extension, modification, or denial of continued services.

• Children and Family Treatment and Support Services (CFTSS): Children and Family Treatment and Support Services (CFTSS) are a set of six Medicaid State Plan services designed to increase access to preventive, early intervention, and treatment services for children and youth with behavioral health needs. These services offer flexible, community-based supports that focus on improving functioning and reducing the need for higher levels of care. Eligible services include:
  • Community Psychiatric Supports & Treatment (CPST)
  • Psychosocial Rehabilitation (PSR)
  • Family Peer Support Services (FPSS)
  • Youth Peer Support (YPS)
  • Other Licensed Practitioner (OLP)
  • Crisis Intervention (CI)

Frequently Asked Questions

1. Will Healthfirst be conducting concurrent review on CFTSS?

Yes, but concurrent review of services will apply only to CPST and PSR services. At this time, no concurrent review is being performed for the other four CFTSS services (OLP, CI, FPSS, YPS).

2. Is Healthfirst requiring Concurrent Review for CPST and PSR?

Yes. Additionally providers are advised to indicate the first visit date of CPST and/or PSR on the CFTSS Continuing Authorization Request Form for notification purposes. Healthfirst will conduct concurrent reviews starting with the fourth visit.

3. What is the significance of the first service date on the concurrent review form?

The continuing authorization form includes a section where providers must indicate the date of the first CPST and/or PSR service to ensure the first three visits are recognized and prevent claims delays.

The initial service date is critical for aligning the review period with the service timeline. This date triggers the “first three visits” count. If the date is inaccurate or missing, it may cause billing or authorization mismatches.

4. How should providers submit concurrent review requests for PSR and CPST?

Submit the Children and Family Treatment Supports Service Continuing Authorization Request Form before the fourth visit for both PSR and CPST. Email completed forms to: CFTSSINFO@healthfirst.org.

5. What information is required on the Authorization Request Form?
The form must include:

• Member and provider information
• Type of service requested (PSR or CPST)
• CPT/service codes
• Duration and frequency of requested services
• Clinical goals, objectives, and rationale

6. What documentation is required?
To request services beyond the third visit, providers must submit:

• A treatment plan with measurable goals. If a treatment plan is not yet established at the time of submission, it must be provided within 5 business days, and no later than 35 days from the service start date.
• The completed Children and Family Treatment Supports Service Continuing Authorization Request Form
• Recommended documentation (optional):
  • Recent progress notes
  • Recent safety plan
  • Recent psychiatric evaluation/biopsychosocial
  • Letter of support from a Licensed Practitioner of the Healing Arts (LPHA)

7. What level of detail is expected regarding frequency and intensity of services?
To help reviewers assess appropriateness based on diagnosis, needs, and goals, providers must specify:

• Number of sessions per week/month
• Expected service duration per session
• Clinical justification for intensity and frequency

8. What is expected regarding the goals?
Goals should be:

• Results-oriented
• Measurable
• Achievable within the treatment timeframe

9. What happens if a partial approval is issued?
In some cases, Healthfirst may approve fewer sessions or a shorter timeframe than requested. If a partial approval is issued, the decision will be communicated to the provider. Providers are responsible for tracking approved units and submitting follow-up requests as
needed.

10. How should claims be submitted?
Claims for PSR and CPST should be submitted in chronological order. Submitting claims out of sequence may lead to review misalignment, denied claims, and/or delayed payments.

11. How should providers approach the transition for members who are already receiving PSR and CPST?
Healthfirst has developed a transition process and related steps, which will be shared in upcoming training sessions and via email. In the meantime, providers should begin identifying members who are currently receiving services and who will continue those services after September 1, 2025, along with current frequency and duration. This information will ensure a smooth transition.

12. Will training be available?
Yes. Virtual webinars and 1:1 provider support will be available. Please contact your Network Account Manager to schedule or request additional assistance

Resources

• Medicaid State Plan Children and Family Treatment and Support Services
• Child and Family Treatment and Support Services April 2025 Provider Manual
• Children and Family Treatment Supports Service Continuing Authorization Request Form

Questions?

Contact your Network Account Manager or reach out to Provider Services at 1-888-801-1660 Monday–Friday, 8:30am–5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).