MedicaidCoverageMedium impact
Functional Family Therapy - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Pediatrics·Medicaid
Effective date
Apr 30, 2023
We identified it
Jun 25, 2026
Summary
Humana Healthy Horizons Louisiana Medicaid has issued a clinical coverage policy for Functional Family Therapy (FFT) and Functional Family Therapy-Child Welfare (FFT-CW) effective April 30, 2023. This is an annual review update (10/22/2024) with minor grammatical changes. The policy establishes medical necessity criteria, billing restrictions (FFT cannot be billed with PRTF services), allowable concurrent services (medication management, individual therapy, CPST, PSR, ILSB), and discharge criteria for Louisiana Medicaid members ages 10-18 (0-18 for FFT-CW) with externalizing behaviors.
Action Required
REQUIREMENTS:
- Immediately: Billing and clinical teams must review and implement this policy for all Louisiana Medicaid claims (Humana Healthy Horizons). Ensure providers understand the age ranges (FFT: 10-18; FFT-CW: 0-18) and eligibility criteria.
- Before submitting FFT claims: Verify medical necessity documentation includes ALL required elements: (1) DSM-5 diagnosis as primary focus (disruptive/externalizing behavior disorder), (2) externalizing behaviors adversely affecting family functioning, (3) documented need for intensive in-home service, (4) at least one willing/available adult caregiver, (5) functional impairment not solely from autism spectrum disorder or intellectual disability.
- Billing team must configure system rules: STOP billing FFT in conjunction with PRTF services. FFT MAY be billed concurrently with medication management/assessment, individual therapy, CPST, PSR, or ILSB ONLY if: clear distinct treatment goals exist, services coordinate without overlap, and youth has high-level need justifying treatment intensity.
- Providers must document discharge criteria met before ending FFT: (1) all program components completed, (2) treatment goals substantially met, (3) member meets criteria for different level of care, (4) lack of engagement despite barrier-addressing efforts, or (5) withdrawn consent/no reasonable expectation of progress.
- Update prior authorization templates and encounter forms to include FFT eligibility and medical necessity checklist to prevent claim denials. Failure to comply with billing restrictions (FFT + PRTF) will result in claim denials.