MedicaidPrior AuthMedium impact
Functional Family Therapy - MEDICAID - LOUISIANA (Revised)
Humana·LA · Psychiatry, Pediatrics·Medicaid
Effective date
Jul 20, 2026
We identified it
Jul 16, 2026
Summary
Humana Medicaid Louisiana revised its Functional Family Therapy (FFT) and FFT-Child Welfare (FFT-CW) coverage policy effective 07/20/2026, establishing eligibility criteria, prior authorization requirements (up to 6 months), and medical necessity standards for youth ages 10-18 (0-18 for FFT-CW) with externalizing behavioral disorders. The policy defines clear discharge criteria and exclusions, including prohibitions on concurrent behavioral health services unless both family-focused and individually-focused services are clinically necessary.
Action Required
Before 07/20/2026: (1) Billing team must update billing system to flag FFT and FFT-CW services for mandatory prior authorization with maximum 6-month authorization period in Humana Healthy Horizons Louisiana plan; (2) Configure system edits to prevent claims when members are in PRTF, OJJ custody, or receiving concurrent behavioral health services (individual therapy, CPST, PSR, ILSB) unless clinical necessity documentation justifies both services; (3) Providers and clinical staff must document all medical necessity criteria per policy requirements including moderate psychiatric/behavioral conditions, moderate daily living dysfunction, treatment intensity rationale, measurable recovery goals, and family engagement plan; (4) Update prior authorization request forms to require documentation of DSM-5 behavioral health diagnosis as primary focus, functional impairment evidence, and confirmation that youth is not solely impaired by autism spectrum disorder or intellectual disability; (5) Train front-desk and billing staff on eligibility requirements (member age 10-18 for FFT or 0-18 for FFT-CW, caregiver availability, behavioral health DSM-5 diagnosis) to screen at point of scheduling; (6) Establish discharge tracking to monitor when members no longer meet medical necessity (goals met, higher/lower level of care indicated, or lack of engagement). Failure to obtain prior authorization or submit required documentation will result in claim denials.