An Initial Request for Residential Treatment
Once
SASS receives prior approval from eQHealth and confirms RTF placement
within the approved 90 days, the FSP Coordinator will complete and fax the FSP
Residential Placement Form to eQHealth within 3 business days after the
youth’s admission.
CLICK HERE for a copy of the FSP
Residential Placement Form
Please fax the completed form to (800) 418-4039 with a Subj: FSP RTF
Placement.
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 eQHealth Solutions within 3 business days
after the youth’s admission into the new facility.
CLICK HERE for a copy of the 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 eQHealth/HFS of residential placement of the FSP
youth. Once received, eQHealth Solutions 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 eQHealth Solutions within 3 business days after the youth’s
discharge.
CLICK
HERE for a copy of the FSP Residential
Discharge Form
Please fax the completed form to (800) 418-4039 with
a Subj: FSP RTF Discharge