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Fidelis Care would like to notify our providers of an update to our Children and Family Treatment and Support Services (CFTSS) Utilization Review Process.  Effective July 1, 2025, Fidelis Care will begin Utilization Management on certain CFTSS Services with a service date of July 1, 2025 or later. Services rendered and billed through June 30, 2025, will process with no authorization requirements.

Fidelis Care will require notification of the initiation of CFTSS Services, and provider must request prior authorization after the 3^rd Visit for the following services.

• Other Licensed Practitioner (OLP)
• Community Psychiatric Supports and Treatment (CPST)
• Psychosocial Rehabilitation (PSR)
• Family Peer Support Services (FPSS)
• Youth Peer Support and Training (YPST)

All Crisis Intervention Services will remain without authorization requirements.

As a reminder:

• CFTSS Requests should be accompanied by the LPHA Recommendation Form
• New York State Department of Health guidance states that:
  • Treatment services must be a part of a treatment plan including goals and activities necessary to correct or improve conditions discovered during the initial assessment visits. The treatment plan must document the reason(s) why services should be delivered at a location and why this location is most appropriate to meet the unique needs of the child. The discharge plan is part of the treatment/service plan and is developed at the start of service delivery and is regularly reviewed and amended as needed.
  • CFTSS should not be duplicative or delivered at the same time as services otherwise available to the individual through a local educational agency for educational services, or other services such as HCBS.
  • Provision of CFTSS within schools does not duplicate nor can it take the place of school-based programming or services as they differ in nature and scope.

CFTSS Service schedules are key components of clinical information for Utilization Review and must be submitted with other clinical documents at the time of request in order for requests to be processed.

For more information related to Children and Family Treatment and Support Services (CFTSS), please see the following guidance from New York State (NYS):

Children and Family Treatment and Support Services (CFTSS)

Authorization requests may be submitted after June 6, 2025, through the below points of contact:

1. Secure Email: SMBHCFTSSRequests@fideliscare.org
2. Phone: (718) 896-6500, extension 16072

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.