Frequently Asked Questions

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Is a behavioral health diagnosis required for concurrent review of OLP, PSR and CPST?

OLP and CPST do not require a diagnosis to begin the service, however it is likely that a diagnosis and/or documentation of medical necessity would be determined before the point at which concurrent review is needed. PSR, on the other hand, does require a diagnosis for receipt of the service.

Source: UM for CFTSS: OLP, PSR, CPST 9.18.18

Since medication management is not a service under OLP, CPST or PSR, is the 30 visit count inclusive of the child’s clinic visits or doctor visits?

Doctor and clinic visits do not count towards the 30 visits that are authorized as part of concurrent review for OLP, CPST, or PSR.

Source: UM for CFTSS: OLP, PSR, CPST 9.18.18

Will there be a standard form for the child's Treatment plan? For the assessments to determine medical necessity for each service?

There will not be a standard template for the treatment plan. A sample form for recommending services/ documenting medical necessity can be found here: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/docs/example_lpha_recommendation_memo.pdf

No specific assessment tool needs to be completed for a child to access CFTSS; all that is needed is for the child to meet medical necessity criteria for the service.

Care Managers can refer directly to a CFTSS provider who is designated for OLP, for the non-physician licensed behavioral health practitioner to determine medical necessity for any CFTSS.

In addition, any licensed practitioner treating the child (such as their doctor) can make a recommendation to CFTSS by completing a written recommendation to document medical necessity based on clinical judgement.

Source: UM for CFTSS: OLP, PSR, CPST 9.18.18

Please clarify how long transitioning waiver children are authorized for CFTSS. Are they authorized to receive the cross-walked services for one year from initial CANS?

CFTSS are Medicaid State Plan services. Any child on Medicaid can receive these services as long as they continue to meet medical necessity. Waiver eligibility is not required for access to CFTSS.

Source: CFTSS: OLP, PSR, CPST Billing and UM Office Hour 11.15.18