Medicaid B: Residential Level II Family Type (TFC) and Rapid Response

• Clinical Coverage Policy 8D-2
• AH SOW IAFT S5145 22 HA
• ILOS AH Rapid Response S5145 22 Z3
• AH Value Based TFC SOW Multiple Codes
• AH SOW Treatment Foster Care Oregon S5145 22 Z4

Submission Requirements

Therapeutic Foster Care (TFC) S5145 and Intensive Alternative Family Treatment (IAFT) S5145 22 HA
Initial: In Network Providers are eligible for Notification Authorization of up to 180 days.  Out of Network providers are not eligible for Notification Authorization and are required to submit the following:

• Service Authorization Request (SAR)
• Person Centered Plan (PCP) with Service Order
• Comprehensive Clinical Assessment (CCA)

Concurrent:

• Service Authorization Request (SAR)
• Updated Person Centered Plan (PCP)
• Comprehensive Clinical Assessment (CCA) within prior 60 days for continued stay beyond 12 months

Enhanced Therapeutic Foster Care S5145 22 Z1 and Co-Occurring IDD/MHSUD Therapeutic Foster Care S5145 22 Z2
Mandatory referral to Care Coordination

Initial: In Network Providers are eligible for Notification Authorization of up to 180 days.  Out of Network providers are not eligible for Notification Authorization and are required to submit the following:

• Service Authorization Request (SAR)
• Person Centered Plan (PCP)
• Comprehensive Clinical Assessment (CCA)

Concurrent:

• Service Authorization Request (SAR)
• Updated Person Centered Plan (PCP)

Rapid Response S5145 22 Z3

• Service Authorization Request (SAR) beyond unmanaged benefit

Service Definition Authorization Parameters

Therapeutic Foster Care (TFC) S5145 and Intensive Alternative Family Treatment (IAFT) S5145 22 HA
Concurrent: up to 90 days

Enhanced Therapeutic Foster Care S5145 22 Z1 and Co-Occurring IDD/MHSUD Therapeutic Foster Care S5145 22 Z2
Concurrent: up to 3 months

Rapid Response S5145 22 Z3
No authorization required for initial 7 days
Concurrent: up to 7 days
Episode of care not to exceed 21 days