Request for Residential Treatment Services

Requests for Residential Services

Acentra Health's utilization review enables the Department to determine if residential treatment services are medically necessary, reasonable and appropriate for the FSP youth based on their clinical needs. This requires a prior authorization request/approval, and if necessary a request for continued stay by the residential facility for this level of care.

SASS/FSP Coordinator - Residential
Prior Authorization & Placement

If the care plan determines that residential treatment is an appropriate option, the FSP Coordinator will submit a request for prior authorization to Acentra Health. You must first receive an approval letter from Acentra Health to submit along with your RAP to a Residential Treatment Facility. Submit your requests for Residential Prior Authorization online using eQSuite and upload the following required documents:

Submit Residential Prior Auth Online (click here for residential prior auth and placement training guide)

  • Copy of Psychiatric Evaluation
    • Dated within the last 180 days
  • Copy of Psychological Evaluation
    • Dated within last 24 months
    • Must include IQ testing
  • Copy of the current IATP (includes MHA and ITP); OR the IM+CANS

NOTE: The IM+CANS can be accepted up to 180 days from the date of submission

 

An Initial Request for Residential Treatment

Once the CCSO receives prior approval from Acentra Health and confirms RTF placement within the approved
180 days, the FSP Coordinator will complete and fax the FSP Residential Placement
Form to Acentra Health within 3 business days after the youth’s admission.

FSP Residential Placement Form

Please fax the completed form to (800) 418-4039 with a Subj: FSP RTF Placement.

Residential Treatment Facility -
Continued Stay Request

Submit your request to Acentra Health a maximum of 10 business day prior or a minimum of 3 full business days prior to the last approved day. Please submit your requests and upload the two required current documents for residential continued stay online using eQSuite.

Submit Residential Continued Stay Online Training Guides

Remember to upload the following required documents for Continued Stays:

  1. Copy of the current IATP (includes MHA and ITP); OR the IM+CANS
  2. Copy of the Family Success Plan/Discharge Plan

 

A Residential Treatment Facility Transfer

Whenever a residential treatment facility has determined that a youth in its care requires a transfer to another HFS-registered residential treatment facility, the RTF must contact the youth’s FSP Coordinator and provide information why a transfer has been initiated. The SASS/FSP Coordinator will complete and fax the FSP Residential Transfer Form to Acentra Health within 3 business days after the youth’s admission into the new facility.

FSP Residential Transfer Form

Please fax the completed form to (800) 418-4039 with a Subj: FSP RTF Transfer.

IMPORTANT NOTE! These forms are required to notify Acentra Health/HFS of residential placement of the FSP youth. Once received, Acentra Health will send a letter to the appropriate Residential Treatment Facility authorizing an initial 60 days of residential care. The letter will contain the approved dates of service, separated into two, 30-day stays for billing purposes.

NEW! Residential Treatment Facility Discharge

Effective immediately, when a residential treatment center discharges a Family Support Program (FSP) youth from their facility the Residential Treatment Facility must complete and fax the FSP Residential Discharge Form to Acentra Health within 3 business days after the youth’s discharge.

FSP Residential Discharge Form

Please fax the completed form to (800) 418-4039 with a Subj: FSP RTF Discharge